Thursday, July 03, 2003

The new hour limits went into effect nationwide on Tuesday, but in New York State they have been a way of life for several years. Following the death of Libby Zion in a New York City hospital the state initiated work hour limits for their residents in all training programs, amongst other things. In the April 2003 issue of Annals of Surgery (abstract only) link Whang et.al. report a survey of surgical residents’ opinions of work hour limits. Some findings:
63.8 percent stated that the changes somewhat or much improved how rested they felt
65.7 percent stated that the changes somewhat or much improved their life outside the hospital
How very nice, now for the other edge of the sword:
50.4 percent stated the number of operations they participated in were much or somewhat fewer, 43. 5 percent said there was no change.
34.9 percent stated that the quality of care was somewhat or much worse, while 44 percent stated no change.
60.4 percent stated continuity of care was somewhat or much worse, 33 percent stated there was no change.
Even more revealing is a schism that is seen between junior and senior residents. Senior residents, at sometimes close to a two-to-one margin state that life in the hospital, quality of training, and quality of patient care were somewhat worse or much worse. Some of this may be due to more exposure to “surgical machismo”, old fogeyness (walked to the hospital barefoot in a blizzard uphill both ways…ect why can’t the new kids), or the fact that the senior resident’s workload has INCREASED with work hour limits.
But how can that be??
The junior members of a surgical service occupy themselves with the “scut-work” that we all know and love (changing dressings, pulling drains ect…), while the senior members went off to the operating room. Since the junior residents have to leave post-call, this work falls on the senior residents. I have heard many complaints from the residents where I trained about this (my program initated limits about nine months earlier). The senior residents are even doing cases usually reserved for the younger residents (hernias, breast biopsies) because of hour limits.
One problem with the survey was the response rate, only 319 of 1037 reponded to the questions.
I feel that residents need some relief from the non-clinical aspects of their training, and not be used as cheap labor by training hospitals. But when case numbers, quality of training, and patient care suffer, the residents and their future patients are going to pay the price.

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