{"id":3735,"date":"2014-03-29T15:33:12","date_gmt":"2014-03-29T20:33:12","guid":{"rendered":"https:\/\/mindonmed.com\/?p=3735"},"modified":"2018-02-09T12:48:01","modified_gmt":"2018-02-09T17:48:01","slug":"residency-work-hour-restrictions","status":"publish","type":"post","link":"https:\/\/old.mindonmed.com\/2014\/03\/residency-work-hour-restrictions.html","title":{"rendered":"Residency Work Hour Restrictions"},"content":{"rendered":"

The Grass Is Always Greener?
\nGrowing Up in the Era of Work-Hour Restrictions<\/em><\/h1>\n

\"TiredIn 2008, the\u00a0IOM study on resident work hours<\/a>\u00a0came out and in the years that followed the Accreditation Council for Graduate Medical Education (ACGME) subsequently implemented a gamut of \u201crecommendations.\u201d As a medical student, I remember thinking it was a much needed change \u2013 why wouldn\u2019t it be a good idea to improve patient safety and decrease resident fatigue?<\/p>\n

Alas, as a newly minted intern growing up in the era of work-hour regulations, it\u2019s become apparent that many of these changes may actually make life harder without achieving their main goal of improving patient care.<\/p>\n

The\u00a080-hour work week cap<\/a>\u00a0is fine; it\u2019s been in effect on its own since 2003 and overall it seems to have made residency more humane. Most programs have found reasonable ways to limit work hours to this full-time-times-two amount, at least when hours are averaged over four-week periods.<\/p>\n

However, the additional bullet point \u201crecommendations\u201d from 2010 seem to play out very differently in real life than they do on paper. Many of them seem to be arbitrary lines drawn in political sands hiding behind a facade of patient safety, but that\u2019s another blog for another time.<\/p>\n

So, what do the bullet point regulations look like in the hospital?<\/p>\n

They look like:\u00a0Interns\u00a0can\u2019t<\/strong>\u00a0work 24-hour shifts.\u00a0<\/em><\/p>\n

So, what used to be a two-and-a-half shift weekend turns into a four shift weekend. At a four intern\/year program like mine, that means instead of two people splitting the weekends and having a post-call day after 24 hours on, one intern is committed to night-float six nights\/week for a month while the remaining three interns take the three leftover weekend shifts. The result:\u00a0Fewer hours at a time in the hospital, but more working days in a row and more days\/month away from your family.<\/em><\/p>\n

Is that worse than working a 24-hour shift? I\u2019m not sure it is. It\u2019s certainly not better, though, and I\u2019ve yet to see convincing data that it\u2019s made\u00a0drastic improvements<\/a>\u00a0in patient care; I have seen a few\u00a0mildly convincing<\/a>\u00a0reports that it\u2019s potentially\u00a0done the opposite<\/a>. What it has definitely done is make scheduling and coverage more stressful and taxing.<\/p>\n

I tend to agree with this recent JAMA article suggesting limiting hours without changing workload is\u00a0completely counterproductive<\/a>. I do, however, consider myself incredibly lucky to be a resident at a humane program that takes care of its residents.<\/p>\n

The regulations seem to be put into place without regard to specialty or program size, which could be the fundamental flaw. What works for primarily clinical specialties like Family Practice and Pediatrics may never work for primarily surgical specialties like General Surgery or for mixed surgical specialties like Ob\/Gyn and Orthopedics. In politics and in medicine, blanket regulations, while easier to create, track and implement, rarely achieve proposed goals on a global level.<\/p>\n

I guess it won\u2019t matter for me too long \u2013 come July 1, 2014 I move up in the ranks to \u201c2nd year\u201d and am suddenly capable of working a 24-hour shift\u2026yet another\u00a0arbitrary line<\/a>\u00a0those bullet points draw in the proverbial sand.<\/p>\n

What do work hour restrictions look like in your hospital?<\/p>\n

\u00a0<\/address>\n
I originally wrote this post for my monthly column over at\u00a0The American Resident Project<\/a>, a collaborative blog with some of the best resident and medical student bloggers that I some how got invited to participate in.\u00a0Check it out here.<\/a><\/address>\n
\u00a0<\/address>\n
\u00a0<\/address>\n

Image Credit: imagerymajestic<\/a> | freedigitalphotos.net<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

The Grass Is Always Greener? Growing Up in the Era of Work-Hour Restrictions In 2008, the\u00a0IOM study on resident work hours\u00a0came out and in the years that followed the Accreditation Council for Graduate Medical Education (ACGME) subsequently implemented a gamut of \u201crecommendations.\u201d As a medical student, I remember thinking it was a much needed change […]<\/p>\n","protected":false},"author":1,"featured_media":3740,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[38,106,583],"tags":[519,522,520,521,524,525,523,200,197,517,518],"jetpack_featured_media_url":"https:\/\/old.mindonmed.com\/wp-content\/uploads\/2014\/03\/ID-100120007.jpg","_links":{"self":[{"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/posts\/3735"}],"collection":[{"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/comments?post=3735"}],"version-history":[{"count":9,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/posts\/3735\/revisions"}],"predecessor-version":[{"id":3745,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/posts\/3735\/revisions\/3745"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/media\/3740"}],"wp:attachment":[{"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/media?parent=3735"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/categories?post=3735"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/old.mindonmed.com\/wp-json\/wp\/v2\/tags?post=3735"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}