Below are the responses we received from readers, with identifying information removed.
We are in an era when we asking residents to cite the evidence for what they do (evidence-based medicine). The ACGME has made a substantive change in the process of education without a shred of evidence to say that it is better, or worse, in terms of the education of a physician. It is an embarrassment.
We now have residents who are awake but have less experience.
Before, we had experienced residents functioning at less than 100 percent. Now, we have residents who leave at five, just like secretaries.
What's better, an awake resident who doesn't know a lot, or a tired one who knows more but is functioning at 85 percent?
The first one is at 0 percent. The second is at 85 percent.
Being rested cannot compensate for ignorance.
The 80-hour work week exacerbates a continuing tendency in medicine to make pediatric residency and likely other similar residencies an inpatient, hospitalist training with emphasis on the care of serious life-threatening illnesses and with much less outpatient emphasis and chronic disease training as well as preventive care.
The institutional need for inpatient care by residents, especially ICU care, plus the 80-hour work week has also worked against outpatient, chronic disease medical and pediatric subspecialties and fellowships by making inpatient ICU and procedural subspecialties appear more germane, more exciting, more attractive while the real world of outpatient primary and subspecialty care is given short shrift. This compounds the error of emphasizing primary care in US medical schools in the 1990s, which stigmatized subspecialties and led to the major subspecialty workforce shortages currently seen throughout the US.
The 80-hour work week may have benefits, but it has ripple effects and unintended consequences that are unfortunate.
The number of duty hours is the right question. But did we come up with the right parameters and the right answer?
One can not debate that long clinical duty hours are associated with greater potential for a decrease in clinical performance. Many industries, including the airlines, learned this long ago. But is limiting the work week to 80 hours the answer? Is the total number of hours worked in a week the real issue? Or, is the issue the total number of consecutive hours worked?
The number of consecutive hours worked in a 24-hour period, regardless of the number of hours worked in the week, is the important issue. Currently, residency programs can schedule a resident to work 24 consecutive hours, or even 30 hours, and be compliant with duty hour requirements. If our goal is to avoid the decrease in clinical performance related to long duty hours, it would be better to limit consecutive duty hours rather than focusing on the total hours worked per week.
Limiting consecutive duty hours to 14 hours would go a long way toward eliminating the decrease in clinical performance related to the number of consecutive hours providing clinical care. This can be achieved in all programs, leading to a healthier lifestyle for our learners and a safer environment for our patients.
Content provided by: Graduate Medical Education
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