Medical Residents: Overworked Overloaded Overbooked

Residency is meant to train and prepare future doctors about a wide variety of cases, time pressures, and the unexpected aspects that comes with medicine. Many people argue that residents are being overworked in hospitals, leading to complications and mistakes made by sleep deprived residents who are overworked and underpaid.

 If we were to cut these hours- how prepared will our future doctors be to care of us and our families? Here, the patient's health and quality of care are being put into jeopardy as well as the hospitals reputation. Traditionally, residents were allowed to work between 30-24 hours without a break.

 In 2011, the Accreditation Council for Graduate Medical Education, implemented new rules to cut back the number of hours to consecutive hours or in other words 80 work hours per week in hospitals. This was implemented so that patients would be better protected from errors of fatigued residents. However, the severe cut in work hours, has its consequences as interns are expected to perform the same amount of work in half the time.

 A system needs to be created so that the number of doctors in training increases but one that also lightens their workload. Although work hours went down in 2011, depression symptoms stayed the same according to JAMA Internal Medicine (B).

 

 “In the year before the new duty hour rules took effect, 19.9 percent of the interns reported committing an error that harmed a patient, but this percentage went up to 23.3 percent after the new rules went into effect,” he says. “That’s a 15 to 20 percent increase in errors -- a pretty dramatic uptick, especially when you consider that part of the reason these work-hour rules were put into place was to reduce errors.”(B)

Recently, I read a very interesting article online from the Times, that asked a very good question, "Are Today's New Surgeons Unprepared?" By Pauline W. Chen M.D. Where she wrote about her experience in the field how a doctor's performance in the OR changed her perception of residency. This exceptional physician performed an operation that would have taken most surgeons three or four hours with few complications, just an hour for him to complete. After watching this remarkable doctor breeze through such a challenging surgery, she had to asked him his secret. And his secret was just practice, practice, practice.

“It’s doing the operations over and over and over again,” he said. He described the hundreds of operations he had participated in during his residency and the final years of training when he felt as if he were “living, breathing and eating surgery. I could have done these operations with my eyes closed,” he said grinning. (A)

Previous generations of residents participated in at least one operation a day, nowadays residents are lucky to be involved in two or three operations each week. Subsequently, the bond between a surgeon's operative skill, the number of operations performed and patient outcomes, is a strong one.

These new time limits are creating more problems as they are giving physicians unreasonable workloads in a short period of time that has consequently lowered the quality of care to patients tremendously. Majority of new residents have reported that they have indeed committed medical errors that harmed patients due to the 2011 time rules. 

“You can’t keep asking these young doctors to do more and more work in less time without affecting patient care,” Dr. Goitein said. “Until we address the problem of overwork, we’re just playing a shell game.”(B)

Links:
(A) http://well.blogs.nytimes.com/2013/12/12/are-todays-new-surgeons-unprepared/?ref=health&_r=1
(B) http://www.uofmhealth.org/news/archive/201303/paradox-young-docs-new-work-hour-restrictions-may-increase
(C)http://well.blogs.nytimes.com/2013/04/18/doing-the-math-on-resident-work-hours/

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