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Debating the Physician Work Week

08 Jun

If you’ve ever watched a medical television show or movie, visited an emergency room, or been personally acquainted with a physician, you know that medical education is a long, arduous process. The biochemistry and anatomy courses aren’t the thing that people complain about, though. Sure, they’re hard work, but ask any physician and they’ll tell you that residency is the hardest part of medical education. Why? Because–until recently (and some would say still)–you were made to burn both ends of the candle and then collect the melted wax, reshape it using your shoelace as a wick and light it once more. Translation: They work you to death.

The reasoning is that you get to see and do more if you’re actually around the hospital, and because no one can predict when an interesting case will present, they want you there as much as possible. That thinking led in some cases to residents working as long as two straight days–almost never leaving the hospital, sleeping in “on-call” rooms, and logging well upwards of 100 hours of work each week. Fortunately, some relatively recent guidelines issued by the Accreditation Council for Graduate Medical Education has begun to place limits on residents’ work hours–for both their safety and that of their patients. While these are just guidelines, and not legally enforceable, residents are supposedly not permitted to work more than 30 hours in a single shift or 80 hours per week. Yeah, they only have to work two full-time jobs. Still, many programs find creative loopholes to skirt the guidelines. If you want to get a good feel for how grueling residency is, you should read this.

It’s clear that the medical profession is attached to the tradition of a hellish residency and is resistant to too much change, perhaps seeing it as a rite of passage. But what does the American public think? Well, thanks to a new study published by Alex Blum and colleagues, we have an idea: The public underestimates how much residents actually work and thinks they should work even less than that.

Of the 1,200 people surveyed, the mean estimate was that residents work a 12.9 hour shift and a 58.3 hour work week. The survey respondents felt, on average, that a 10.9 hour shift was long enough, and that the work week should be capped at 50 hours. As an aside, recall that the current cap is 80 hours a week–60% higher than the public’s ideal. There was also overwhelming consensus that if residents didn’t have to work as much, medical errors would decrease. That might be related to the finding that 81% of respondents would like to be informed if their resident had been working more than 24 hours at the time they were seen. Similarly, 80% report that they would ask for a different doctor if they found out that their resident had been working for more than a day. Think about it. Would you want your airplane pilot taking off during hour 26? I sure wouldn’t. All this begs the question: If the residents don’t want it, and their patients don’t want it, why doesn’t it change?

I asked for insight from one of the study’s authors, and he wasn’t entirely sure. He did disagree with my suggestion that it all had to do with the difficulty of changing the status quo–something I called professional inertia–saying “Inertia is an insufficient explanation for where we are. Economics might be.” He didn’t elaborate it on this point, but it gave me the impression that residents are a much cheaper way to staff a hospital than board certified attendings are. I think there’s a research project of the cost-benefit variety in there somewhere.

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Posted by on June 8, 2010 in Uncategorized

 

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