Enough Is Enough: Time To Reevaluate Impact of Residency Training Rules

Shocking, simply shocking. A recent article highlighted unintended consequences of the most recent changes in resident work hour rules.

Why does the ACGME impose work hour restrictions without considering unintended consequences like increased medical errors due to increased patient hand offs?

I graduated residency in the “dark ages” (1999) but rarely worked more than 80 hours a week.  While rounding post call was never pleasant, it did prepare me for “real life.” Today, I worked 12 hours in the clinic then drove 3 hours to the state capitol so I could testify in support of expanded funding for family medicine residencies.  In my first 7 years of practice doing family medicine with Ob and hospital work, I took call for 1 week at a time while covering my own Ob patients 24-7.

The ACGME seems to extrapolate from existing data without studying the impact of its past actions. As a surgeon medical  school classmate of mine says, life has no work hour rules. A rural physician colleague who still does C sections and appendectomies told me last month he no longer hires third year family medicine residents from his own alma mater because they don’t have enough experience.  He only hires grads who complete the program’s 1 year rural medicine fellowship.  When I see graduates of the program where I am now faculty say they can’t do inpatient and outpatient medicine at the same time, our training model is gravely flawed and further fragments health care at a time when more well-trained generalists are needed.

Categories: Uncategorized | 2 Comments

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2 thoughts on “Enough Is Enough: Time To Reevaluate Impact of Residency Training Rules

  1. Neeraj

    What a fucking joke. Someone who in his own words, “rarely worked more than 80 hours a week” commenting on something he hardly knows anything about.

    80 hours a week of actual patient care is plenty. I don’t know where you did residency, but at least here in NYC where I am training and Chicago where I went to medical school (but to a less degree) some where on the order of 1/2 of the time spent in the hospital is spent doing non-medical administrative BS. Hospitals (ab)use residents as cheap labor; the issue isn’t 80 hours, it’s spending those 80 hours doing nonsense instead of making decisions. Learning how to call the lab 5x / day to get a test drawn or pestering the nurse / phlebotomist to draw labs is not something that I need training in.

    I’m sorry that you had to train in the “dark ages.” Fact is, you did family medicine and still didn’t push 80 hrs. If hospitals had their way, as they once did prior to the massive resident strike in the 60s (not sure about the date, may have been the 50s), Interns were literally in the hospital 24 hrs / day and were unpaid. Maybe we should go back to that?

    OR maybe we should regular WHAT residents do as well as HOW long they do it for.

    You’re right, life has no work house rules; you can choose to work more or less, but that’s up to you. If you want to work in a practice that makes you take call all the time you can do that and you’ll be compensated for it; OR you can work less and be compensated less. When you don’t have a choice, there have to rational limits, especially when your salary is being paid by the federal government.

    W/ regard to your Rural Medicine friend, I suspect two things have happened:
    1. He thinks too much of himself and doesn’t remember how green he was when he first started. Its pretty common amongst mid-career physicians in their 40s and 50s.
    2. The quality of the grads has decreased a bit from when he graduated, but not as much as he thinks. Why? While the intention of 80 hrs was to give residents some time off, that’s is not what actually happened; Let’s say for example in the typical 100 hr work week of a resident, 50% is spent on patient care and 50% is spent on administrative bs (in reality I would think it’s more like 10:90, but whatever). If you’re limited to 80 hrs, guess which 20% is going to get cut? The patient care.

    I challenge you to respond to my critique.

  2. neerajmodi

    Published in the NYTimes two days after I wrote my diatribe on your blog


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