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Limiting student doctors' hours cuts both ways
June 14th, 2011
08:27 AM ET

Limiting student doctors' hours cuts both ways

There are growing concerns that limits on the long hours medical interns and residents can work could affect their readiness to practice medicine.

Four years ago, the union that protects interns and residents, called the Committee of Interns and Residents, was successful in decreasing their hours per shift from 30 to 16. Some doctors think that limit may be curtailing the new doctors' education.

“More often than not, I get, ‘Well I have to go, my time’s up,’ said ER doctor Celina Barba. “Definitely the attitude is 'my need to leave is more important than my need to learn.'”

Barba knows the stress of long, exhausting shifts under extreme pressure.  She understands that the interns and residents are torn between caring for their patients and abiding by the hours-limit rule. The young residents want to work, but if the rules are violated, it could affect a program’s accreditation.

Dr. Michael Core is a medical resident at Harbor/UCLA Medical Center in Los Angeles . He’s also the regional vice president for the Southern California chapter of residents' union.

“We’re a different kind of union,” said Core. “We’re a union that focuses not only on resident well being and function, but also the well being of our hospitals and the well being of our patients. Because that’s ultimately what matters.”

The hour limits were imposed after reports of residents falling asleep at the wheel and mixing up medications.

The union can be found in most major public hospitals in New York, where the union began; New Jersey; New Mexico; Miami; Washington, D.C.;  California; and Puerto Rico.

Those who train residents worry about the limits.  A 2007 study published in a medical industry publication, shows 87% of faculty surveyed said residents’ continuity of care declined after duty-hour limits were imposed. Dr. Barbara Schuster, dean of the Georgia Health Services University at the University of Georgia, says there may need to be adjustments to how residents are learning the trade if more hours aren’t an option.

Click play below to hear the complete story from CNN Radio.



soundoff (160 Responses)
  1. CurrentResident

    It's nice to know so many medical professionals have opinions on work hour restrictions and residency programs lengths. My question to all of you is instead of commenting here, why not send all of your comments to the ACGME, or even Congress? (though I doubt congress people will read anyone's comment due to the flood of pharmaceutical and insurance lobbyist garbage filling their desks, minds, and perhaps their pockets).

    One thing is sure, a change is needed in the way doctors are trained... While we're at it we should change the fact that more and more often medical decisions are made because of legal and not medical reasons. Let's take back medicine, but first let's prepare for it!

    June 14, 2011 at 17:39 | Report abuse | Reply
    • Larry051967

      The long hours equal forced labor for the hospital. Their business plan is based on that, like the old nursing schools where one worked of their tuition as they went to school. I have always wondered if that made for good nurses?

      June 14, 2011 at 21:40 | Report abuse |
    • charles s

      How do other countries handle these training issues? Do interns in Europe have to do 80 hours weeks in order to become skilled doctors? Or is it just in the US? I am not a doctor but I make use of their services from time to time and I would like to know that they are well trained. My chief concern is being a patient to some intern who has not slept in 30 hours.

      Not far from where I live, a nurse was going home after a night shift and fell asleep. Her car went off the road and killed a girl. Doctors are humans and I do not beleive that they can properly function without enough sleep. Having a tired intern operate on a person is asking for a mistake that might kill someone. Is that the price that patients have to pay to train a doctor?

      June 15, 2011 at 12:32 | Report abuse |
    • medstd

      @charles, Their Residencies are longer, sometimes by up to two years, But not as many hours per week.

      June 15, 2011 at 16:01 | Report abuse |
  2. ramparts1815

    It's not hours worked....it's the mentality of residents themselves. If you're a resident and you enter my OR, you better know the patient, the surgery, and have some idea of the steps involved in the surgery. You better have some idea of how to manage the patient post-operatively. 80 hours doesn't mean you don't prepare for the next day or week. Residency is not shift work. 80 hours in the hospital does not mean 0 hours reading/learning material at home. I've gotten phone calls from surgery groups that are headed by colleagues, classmates, and even former residents who have expressed serious concern about the recent crop of residents that have graduated our program and joined their practices. It is very alarming to see that some of these surgery groups have resorted to proctor recent grads of our programs for up to 2 years! I'm told these recent grads know less and can do less than graduates 5 years ago. We've had a big problem with this and are trying to address this in our educational committee. More didatic lectures do not work, we've tried that. It's really up to the resident to be proactive to learn. I do not need him/her to run my service. I can make do with our PAs. But I would like to see our residents step up to the task and be able to run our services while using as consultants. In fact, we may have to look into extending surgery residency for another year even. And the public should realize that really good doctors and surgeons peak at 5-10 years after training.
    Since work hours are here to stay, I would advocate a rigorous competency test both written and clinical to allow residents to graduate from year to year. If you don't perform, you do that year over. It's the best way to ensure fully qualified individuals are graduating from our program. It may take some people 5 years others 10 years. But in the end, we have produced a quality physician.

    June 14, 2011 at 17:57 | Report abuse | Reply
    • SurgRes

      Bollocks. I am a resident myself. Make sure the residents have to do less paperwork and it will work out. The problem with people like you is that they believe becoming a good physician requires 80hr weeks which couldn't be further from the truth. I bet that one could reduce work hours even more and training wouldn't suffer if all the unnecessary paperwork would be reduced. Pretty much everybody working with patients knows that. And if you feel your residents are less well trained now that they work fewer hours, maybe it's the clinic's fault and not the resident's one. Yet it's the older physicians who believe that because they had to work hard, everybody else should too. Medicine needs progress to advance. It's time this progress also takes place in the minds of older physicians.

      June 14, 2011 at 18:51 | Report abuse |
    • christian

      I've had the same conversation with colleagues, and the problem is you can't work ethic. We had a very smart resident, knew all the bookwork, but was L A Z Y. Didn't know the patient, didn't pre-round, little things weren't done before rounds, and we had almost no leeway to reprimand because of the ACGME and such. Some get it, some don't when it comes to work hours and how to learn.
      Also, it kills me that residents would actually report being one hour over limit, which could put the very program they hope to graduate from at risk losing accreditation! I am not that old, but I can already start sentences with " when I was a resident/fellow..." :-)

      June 14, 2011 at 19:06 | Report abuse |
    • christian

      Should say can't teach work ethic! Sorry to the grammar police!

      June 14, 2011 at 19:06 | Report abuse |
    • SmarterThanYou

      I have an impression that surgeons have difficulty thinking outside the box and live in the past, lightly saying. If working someone 80 hours per week is not legal slavery and sadism in the western world then I do not know what is. However, if you're correct, and more time is needed to breed a competent surgeon or a doctor, then increase the length of residency and not the hours. Can you bend you logic a bit or you are mentally in 1980? I want to learn and be more competent but I also want to live rather that turn the best years of my life into a bloody pulp just because that was the way "we did it" in the 80's. Can you understand it?

      June 14, 2011 at 21:46 | Report abuse |
    • Tobash

      I just completed my residency on Orthopaedics. Residency and on-call/scut work are two different issues.
      There is no way that a smart individual can't learn how and when to do surgery over a 5 year residency.
      On-call and scut are another issue. On-call and scut are code for sleepless hours of minimal learning. It is a myth that overnight work aides learning. There are no illnesses I ever saw at night that I did not see during the day. There are no surgeries I performed at night that I did not perform during the day. There is also no education in staying up all night to write routine medication orders. There is no reason for residents to be forced to work full days and then overnight. Recent reports show increased cancer risk in persons doing overnight shift work. Just as importantly, tired doctors don't perform.
      On-call is about $. Hospitals are reluctant to hire physician's assistants as they cost 100k per annum when residents cost 2/3 that, PA's have unions while residents don't get effective union protection, and residents can easily be threatened with expulsion if they don't work hard enough while PA's are protected. In addition residents generate $ for hospitals, and because they are doctors the work they do is reimbursed at a higher rate than PA's who cover emergency rooms. Essentially residents are indentured servants. I also laugh when attending staff whine and complain that they learned more, when we have the ever increasing textbooks due to ever increasing volumes of knowledge we must know in order to pass our board exams. Attending staff from just 10 years ago know almost nothing of genetics, specialized immunohistochemical pathology stains, statistics, evidence based medicine, mandatory communication skills, medical ethics, etc... If we as physicians are required to know ever increasing volumes of information, residency programs need to allow for concomitant increases in study time. Ultimately medical residency is about the quality of teaching, the quality of the learning time residents are given, and not the number of hours worked. I was fortunate in that my residency program recognized these issues and made allowances for them. I now will be more humble and understanding of my future residents' requirements. It is my job to care for my patients and teach my residents. It is their job to learn how to care for my patients and learn the art of Medicine. It is not their job to shoulder all of my responsibility while also struggling to learn in an unforgiving environment. I think Hippocrates would want me to teach, not to slave drive.

      June 15, 2011 at 03:26 | Report abuse |
    • just me

      @ramparts1815: Sadly, the work ethic is just gone. I hope to never have to entrust my healthcare into the hands of one of these "doctors" who whine about having to put in the time........

      June 15, 2011 at 08:33 | Report abuse |
    • Resident'sWife

      JustMe... have you ever worked more than 40 hours a week? 80 hours a week is more than sufficient "time" to put in. If you think you are tired at the end of an 8 or even 10 hour workday, imagine how you would feel at the end of a 16 or 30 hour shift. Do you really want someone treating you who has "put the time in" at the end of a 36 or 42 hour shift? Doctors today are just as well trained as previous generations as long as the program is willing to do the training instead of throwing "scut" work at the residents. The hospitals need to shift their mindset from "a resident is cheap labor to take care of everything that no one else wants to do" to "a resident is a valuable future resource and should get as much quality training as possible in their field of choice while they are available." After all, the purpose of a training hospital should be to teach, not squeeze hours and labor out of their residents just for the purpose of profits.

      June 15, 2011 at 10:39 | Report abuse |
    • Med Student

      I am pretty sure that test that you are talking about is Step 1, Step 2 and Step 3....

      June 15, 2011 at 12:34 | Report abuse |
    • NC ER PA

      @ Tobash

      PAs have unions? Really? Since when? And I've never met a PA that can kick back because they are "protected" from expulsion/ termination of employment if they don't work hard enough. That's ridiculous.

      June 16, 2011 at 18:14 | Report abuse |
  3. Mike

    I think that one danger of shift work mentality is lack of patient ownership. If you view your job as making sure nothing bad happens to a patient during your shift this is very different from truly working towards fixing whats wrong. No better/no worse may seem like success

    June 14, 2011 at 19:28 | Report abuse | Reply
    • Resident'sWife

      So Mike, you think the residents should live at the hospital and be available at the hospital 24/7? Otherwise, it is a shift. If the shift is 16 hours or 42 hours, it is still a shift. So, following your logic, the only way to get rid of the "shift" mentality is to require doctors to live at the hospital? No, in the business world when you want an employee to take "ownership" of a project, you make them responsible for their piece of it. There isn't a shift mentality in (successful) businesses even though employees may "only" work 10-12 hours a day.

      Did you know that residents make less than minimum wage if you take the salary they make and divide it by the number of hours they work? Would you be one of the people up in arms if a person who makes minimum wage was required to work 80 hours a week? Yet you deride someone who makes less than minimum wage. Your lack of logic is sad and troubling.

      June 15, 2011 at 10:44 | Report abuse |
    • Mike

      Resident's wife,
      I, having completed residency within the last 10years, know firsthand the good and bad of the whole residency life. I saw firsthand the effort and caring that my fellow residents put forth. I made vastly less as a resident than the salaries now so please do not lecture me on the economics of intership. My perspective is not one who is against limiting time, but I also do not think it is as simple as many here are making it out to be. I now help supervise residents and like all aspects of life there are the good and bad parts. I have noticed that the reduced hours have allowed some of the less motivated residents to dodge work and pass on responsibilities. Clearly this is not the majority, but wereas one resident was predominately responsible for the success/failure of a case in the past it seems now the responsibility is "shared" and this can lead to a lack of ownership. As to limited hours, that's fine but if we limit time/cases when should lengthen programs to account for it. Otherwise the residents will be less experienced when the hit the real (unprotected) world.

      June 15, 2011 at 11:49 | Report abuse |
  4. Jess

    I'm a PA in a surgical field – and while I don't work 30 hour shifts, I regularly work the 60-80 hour weeks that many of the attendings here speak of plus taking call at 4 hospitals. That means if the last surgery or consult is at 230am and the elective schedule starts at 730, I have 5 hours to get home, sleep, and get back to work. And this is just as an assist. Its the nature of the medical beast. We are going to have to lengthen training the more we cut back hours.

    On a side note, those of you who don't feel that your son/daughter/mother/whoever is getting adequate care where they see "just a PA or NP", you are seriously mistaken. I know more about my patients than most surgeons do. I'm the one that meets you in the ER, explains the procedure to you, helps do your surgery, writes your orders, and follows you post-operatively while you are in the hospital. But then again, what do I know? I'm not a doctor.

    June 14, 2011 at 21:15 | Report abuse | Reply
    • John

      If you want to be treated like a doctor, go to medical school.

      June 14, 2011 at 21:58 | Report abuse |
    • Kelly

      John, it is not about being treated like a doctor. It is about being treated with respect. Saying "just a PA or NP" (as jess pointed out) is patronizing and disrespectful to those professions, implying they are not as important or competent as a physician.

      June 14, 2011 at 23:24 | Report abuse |
    • Heidi

      @John

      Arrogant

      June 14, 2011 at 23:33 | Report abuse |
    • Mary

      I agree that PA's are important, and should be treated with respect. But I do not see how they feel they need to be treated as if they are as "competent" as a physician, when they simply Do Not have the same level of training. PAs train for 2 years, physicians train for at least 7. I for one am not comfortable being seen by PA's when I go a physicians office. I agree with John, if you want to be treated like a doctor go to medical school.

      June 15, 2011 at 07:12 | Report abuse |
    • Matt

      @Kelly –

      PAs and NPs are great, they deserve respect. But they aren't as competent and as important as MDs. That's just reality. They should be given the respect they deserve (which is plenty) but there's no need to overstate their importance. If PAs and NPs all vanished there'd be more work for the docs in the practice – if the MDs all vanished there would be no practice.

      July 2, 2011 at 16:23 | Report abuse |
  5. KHeard

    What a coincidence... I was just commenting a few days ago to the affect of, "I'm not all that convinced that I -want- someone (intern) working on me in an ER that has been up for the last day-and-a-half... I wonder if those long hours are really that necessary?"

    June 14, 2011 at 23:00 | Report abuse | Reply
    • Laura

      I agree. It is very frightening for a patient to find out that they are being treated by someone who has been working for the last 36 hours straight. My husband was "treated" in a local ER of a well-respected hospital system by a doctor who had been working for over 30 hours. My husband is a diabetic with a pacemaker and a heart attack and stroke in his medical history. When he went to the ER with a serious case of cellulitis covering his entire lower leg, a fever of 102 and pain so bad that that he could not move without tears coming to his eyes, the ER doctor gave him a prescription for a common antibiotic and told him to come back if it wasn't better in a week. When my husband asked about the pain, the doctor told him to just "deal with it." Two days later, the infection was worse and my husband went back to the ER. The same doctor was there and told my husband to go home again without doing anything for him or helping him with his pain. The next day, we went to another ER and my husband was admitted immediately and had to be on IV antibiotics for over a week. His leg will be scarred for the rest of his life. When my husband went back to tell the first ER doctor what had happened, he said he was sorry my husband was upset but that we had to understand that he had been up for over 30 hours straight so he was a little "cranky." I can only image him telling the family of some person who dies in that ER unnecessarily that they have to understand that he was tired and cranky. When are doctors going to learn that they do not have super powers? You are all human like the rest of us. The fact that you are doctors does not make you any better than your patients. The day they finally start teaching that in medical school will be the day when patients finally start being "cared for" by physicians instead of merely being "seen."

      June 15, 2011 at 00:03 | Report abuse |
  6. Heidi

    test

    June 14, 2011 at 23:19 | Report abuse | Reply
  7. Heidi

    OK, I can post again.

    Folks- remote medicine, telemedicine is the future.
    Home care and ICU's are already making use of this, so are some primary practices.

    It will not be uncommon for doctors in India to be on a shift and continually monitor patients remotely. WIll that eliminate the need for hands on doctors of course not.

    It will help with the shortage though.

    Also remote robotic surgery will gain momentum.

    Lengthing residency makes sense. I am still unconvinced on the rationale that work 16+ hours makes a better doctor. There will always, always be hand-off's. Every human needs sleep.

    Will there be extremely long surgeries- of course. That is inevitable. But my goodness- do not work 20 hours sleep only 5 and then perform surgery on me the next day. No one wants that. You as a doctor requiring oyur own surgery does not want that. Come on!

    It's almost like a fraternity hazing mentaility. I went through it so they have to also. I noticed that with mandatory overtime with nurses too. Nurses would say- I always worked 16 hour mandatory overtime so should you. Thank goodness that no longer occurs b/c it felt like forced slavery. To not be allowed to leave otherwise you would be charged with patient abandonment.

    Anyhow, it is illogical to state that long shifts are the ONLY way to train and teach someone. Or that dedication is less sincere is a person works a shorter shift.

    June 14, 2011 at 23:29 | Report abuse | Reply
    • john

      Curious how robotic surgery will help oncology, hematology, family practice, general medicine, psych, pulmonary, ID or a host of other specialties

      June 22, 2011 at 15:27 | Report abuse |
  8. anesthesia

    This story is biased. No one likes to work 30 hr shifts. It freakin hurts.

    June 15, 2011 at 00:57 | Report abuse | Reply
    • Valentijn

      And I don't want someone that's been working more than 10 hours without some downtime coming anywhere near me in a hospital :-P

      June 15, 2011 at 07:21 | Report abuse |
  9. doctorS

    This article is misinformed. It states that 4 years ago the hours were capped at 16. There is currently not a 16 hour cap on residents. It begins this July and only applies to interns. The other residents will continue to have a rule that states they are not to work more than 30 hrs continuously and should not see new patients after 24 hours. However, if a resident is a senior, he/she may work more than that. Additionally, the maximum hours worked per week is a maximum of 80, averaged over 4 weeks. As a resident, I've worked 109 hours in a week, but as long as my 4 week average is 80 or less, that's fine.

    Training today is completely different than it was 20-30 years ago when the medical field was ruled by male physicians who often had stay at home wives to raise their children. Patients who were hospitalized were often less sick. These days, if you are in the hospital, you are critically ill, and if you are in the ICU, you are at high risk of dying within the next several days. Comparing now to then is impossible. The more hours one spends in the hospital, however, the more they see, learn, and the more autonomous and independent they will become.

    June 15, 2011 at 01:26 | Report abuse | Reply
    • obres

      I was confused at first too. Howvere, they are not reporting the new ACGME standards. They are referring to work limits set by a union in some states. If your state is like mine, no one has ever heard of a union for residents! As a rising chief resident in OB/GYN, I actually do think there is a crisis developing. You become a competet surgeon and clinician by hours and hours of contact. If you limit the hours per day and week (especially for the new interns!) then eventually you will have to lengthen the years of training.

      June 15, 2011 at 09:06 | Report abuse |
    • Pad

      I worked 110 hours one week followed by 102 the next as a lawyer. When work needs to be done, professionals get it done. Period. Now, this talk of 42-hour shifts, as if there is no sleep involved, is just silly. During my 110-hour week, I slept at the office for three straight nights. Was that an 80+ hour shift?

      June 15, 2011 at 13:57 | Report abuse |
    • Tim

      Pad – it depends on the service but very often there is no sleep involved in an overnight call. If an intern is on a 30 hour call, there's a good chance he/she is going to be awake for 30 straight hours (actually more considering drive time to/from home). I'm sure you work hard at your law practice but this is a different beast. I've known residents who worked 100+ hours every week for months at a time.

      July 2, 2011 at 16:28 | Report abuse |
  10. Faith

    I do not want someone treating me that has been working for 24 – 30 hours without a decent period of sleep/rest.

    June 15, 2011 at 06:17 | Report abuse | Reply
  11. Dustin

    From a psychologist's perspective: Proactive Interference is a term used to describe the fact that learning decreases as a function of time spent on a particular subject. Based on this principle, I have to question how much extra information is actually retained in those additional hours.

    June 15, 2011 at 07:46 | Report abuse | Reply
  12. steve

    If the quality of physicians is less it is because the smartest students are no longer choosing medicine. Young potential doctors also realize that the money and respect that physicians used to have is not the same either so why kill themselves? That's the way I felt when I started medical school 20 years ago and chose a residency program that abidded by the Bell Commission recommendation on hours limits. And yes I was in a car accident after working 34 hours straight. And yes I remember being so mentally spent toward the end of those shifts that I was worthless. It is not the time being there it is the pager going off every 3 minutes for 30 hours straight.

    June 15, 2011 at 09:37 | Report abuse | Reply
  13. NJN

    It's about time something is done about the sheer abuse the doctors in training receive. Just because the other doctors had to go through that abuse doesn't mean they have to continue the tradition. That said, I'm not a great believer in 'Time to quit. I'm outta here.' either. In my life it has been: start working when you get there, get the job done, and leave when it is, or you are at a good quitting point.
    Having grown up with the old time 24/7 doctor (Sunday's were called 'prayer service') I really dislike the 5 day a week mentality of many doctors (both human and veterinarian).

    June 15, 2011 at 09:42 | Report abuse | Reply
  14. Resident'sWife

    So, as my screen name says, I am a resident's wife. He is a surgery resident, and his residency program is praised by every new surgical attending who comes in, and is known across the nation for how well the surgeons operate by the time they get out of the program. Their secret? Well, it is easy. The residents start in the operating room the very first year. They get hands on training and it is immediate and thorough. They easily have double or triple the number of cases by the end of their intern year than most interns at other programs. Yet, they still work an average of 80 hours a week (yes, one of the earlier posters have it right, you only have to average 80 hours a week over a 4 week period). So, the previous generation needs to stop complaining about change and figure out how to provide a superior education within the limitation of 80 hours. The education does not have to suffer, and in fact can improve, but only if the residents actually get in and see the patient and interact with the patient more while doing less "scut" work. Doctors these days go into medicine because they care about the patient, as the money is no longer there. You could make more money being a business person. I know, I am a business person, and for my entire career I have made more than my husband. When he leaves residency, as a surgeon, I will still be making as much as he makes and I only have a bachelor's degree. (He could make more if he was willing to live in an underserved area, but that means no large cities and not in the sub-specialty that he wants to practice.) You want more doctors and less of a shortage? Either make it worth the 14 years of training (over half of that not paid) or decrease the "cost of entry" (business term that means how much it costs a person to go into that profession). How many people are willing to give up 14 years of their lives to make the same amount or less than someone who only gave up 4 years of their life? This lack of dedication and work ethic complaint is baloney, as all of the residents that I have met are dedicated people who understand that they will not be able to get rich as a doctor, but are still willing to sacrifice decades out of their lives to take care of sick people.

    June 15, 2011 at 10:29 | Report abuse | Reply
  15. Rankorian

    80 hours a week? When I trained in Internal Medicine, your PGY-1 year was 120 hours a week most rotations, and that was with a Union–in NYC (this is before the Libby Zion case).

    I am not sure what I think about the shorter hours. It is interesting that we are now talking about 80 hours a week being too long.

    I think the general public just never understood what how the actual medical system was run. There are 168 hours in a week. If the physician works 40 hours a week, that would require 4 physician to cover the care of a patient for a week. For years after starting my practice, I used to be on call for the entire 168 hours each week. But times have changed, and the American people are losing the medical system they had.....forever........no matter what

    June 15, 2011 at 10:50 | Report abuse | Reply
    • Pad

      As you note, there are 168 hours in the week. Any claim of working 120+ hours a week on anything more than an emergency basis is bogus. I don't doubt you were at the hospital for 120 hours. I doubt you were awake the entire time, and I suspect eating and socializing was included in that shift time (unlike any other job in America). What it boils down to is hazing, or perpetuating the myth. I see it in the legal field too. The horror stories of law school and studying for the bar are far worse than the actual acts themselves. But, we want everyone else to think how special we are and how difficult it was, so we make sure to exxagerate. That said, all this talk about residents "having" to work 80 hour weeks makes it sound as if once they finish residency, they can cut down to a cool 40-60 hours. If so, I chose the wrong profession because I still work 80-hour weeks on a regular basis (though not weekly as I have gotten older).

      June 15, 2011 at 14:09 | Report abuse |
  16. PediatricResident

    As a current resident, I have seen my program have a fair amount of difficulty changing our schedule around for the new interns coming soon. While 30 hour shifts are tough, the night learning and continuity of care were valuable experiences and I worry that these will be lost.

    On a different note, I wish CNN would clarify their article. "Student Doctor" implies medical student, or a person without a medical degree. Intern / resident / fellow physicians have all completed a medical degree and varying amounts of training afterward. This article could be confusing to patients.

    June 15, 2011 at 11:05 | Report abuse | Reply
  17. sleepdoc

    16,640 Clinical hours vs 22,880 Clinical hours ( 80 per week vs 110 per week). Which Physician do you think is better trained? Seriously, stop whining about hours, and think about how much more confident, experienced, and sound you will be when residency is over.

    What are you going to do when your attending isn't around to bail you out? You are going to have to rely on your fund of knowledge gained in residency. Now doesn't 22880 sound better than 16640?

    June 15, 2011 at 11:21 | Report abuse | Reply
    • Resident'sWife

      That is assuming that after 36 continuous hours you can remember anything that you have been taught. I would much rather see residents train for 16k hours and remember 90% of what they are taught than 22k hours and remember 30% of what they are taught. Now you tell me what is more effective.

      June 15, 2011 at 11:54 | Report abuse |
  18. S in York Township

    Surgical rotation in South Carolina. Wife (now a practiicing MD) would get up at 0430hrs to get to hospital NLT 0530. She would work a continuous shift in a variety of surgeries until 2230-2300hrs. Day two, same as day 1. Day 3, same start but she was required to work continuously from 0530 until 2200hrs the NEXT day. The following day, start at day 1 all over. This was for a two month period. When I say "worked continuously" she was not afforded routine bathroom breaks, food or, for that matter, the ability to attend to other hygiene matters. For comparaisoni, during H*ll Week for Navy Seals, they don't let them handle explosives and they recieve a minimum of 4 hours of sleep. That is 'only' one week.
    My greatest concern for her was her ability to make it home safely in a car. My brother, also a physician, lost one of his residents when he fell asleep and drove off a bridge in Florida after a 39 hour shift.

    June 15, 2011 at 11:36 | Report abuse | Reply
  19. DDM

    Abusive work hours led to these time restrictions. Who wants to be treated by someone who is sleep-deprived? Whenever professions/businesses are allowed to police themselves, they take advantage, so here come the rules from outside. Too bad.

    June 15, 2011 at 12:12 | Report abuse | Reply
  20. OfReason

    At this rate we'll have European quality healthcare in no time!

    June 15, 2011 at 12:14 | Report abuse | Reply
  21. jefe

    Of course the old guard is going to complain about it. Of course the people who benefit from the cheap labor are going to complain. 16 hour shifts is plenty.

    June 15, 2011 at 12:18 | Report abuse | Reply
  22. jj-girl

    Many professions work more than 8 hour shifts. I am a pharmacist. It is standard industry practice for pharmacists to work 14 hours shifts for many large, national chains. Also there are no breaks or lunches during that time. If you want to eat just take a bite between scripts. Do I think it is dangerous? oh yeah....

    June 15, 2011 at 12:52 | Report abuse | Reply
  23. dr.Bill

    It is the time to limit physcians work hours for the safety of patients. Doctors need time to sleep and family just like any other human.

    June 15, 2011 at 12:55 | Report abuse | Reply
  24. The other Mike

    Sleepy residents don't make stupid mistakes......Stupid residents make stupid mistakes. Those who succeed will do so no matter what obstacle, whether it be hours loaded on or something else. You can find this in any field of practice, not just medicine.

    June 15, 2011 at 14:23 | Report abuse | Reply
  25. Fell Asleep with a Scalpel and Stbbed her in the EYE

    Every Physician will tell Tractor Trailer drivers, Bus drivers The Airline pilots and students too – how important it is to have adequate sleep. That to be alert, most ready to lear, react and perform one must absolutely get adequate sleep. And then pull BS like this. Yeah, I'm a Doc, you're a Doc, we have another 24 hours left on shift, let's write each other another prescription for some go pills. Yeah buddy, drove all the way from New York City to San Diego without even taking a nap. Sleep who needs sleep? I'll get plenty of that in the grave.....

    June 15, 2011 at 14:53 | Report abuse | Reply
  26. anesthesia

    The results of a series of studies on total and selective sleep deprivation in the rat are integrated and discussed. These studies showed that total sleep deprivation, paradoxical sleep deprivation, and disruption and/or deprivation of non-rapid eye movement (NREM) sleep produced a reliable syndrome that included death, debilitated appearance, skin lesions, increased food intake, weight loss, increased energy expenditure, decreased body temperature during the late stages of deprivation, increased plasma norepinephrine, and decreased plasma thyroxine. The significance of this syndrome for the function of sleep is not entirely clear, but several changes suggested that sleep may be necessary for effective thermoregulation.

    Rechtschaffen A, Bergmann BM, Everson CA, Kushida CA, Gilliland MA.
    Sleep. 1989 Feb;12(1):68-87.

    June 16, 2011 at 01:13 | Report abuse | Reply
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    June 22, 2013 at 18:31 | Report abuse | Reply
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