Losing Sleep over Residents’ Work Week Restrictions

The Big Picture

Gerald Healy, MD, Children’s Hospital of Boston’s Otolaryngologist-in-Chief and the first otolaryngologist to be President of the American College of Surgeons, said he is not a fan of the IOM’s duty hour restrictions or any program not anchored in research. We wouldn’t give a new drug to patients without thoroughly testing it. So why is the IOM flying by the seat of its pants in assuming that the 80-hour work week is correct? Their report is based on an untested premise, he said.

The impact on surgical training is onerous: You don’t learn surgery from a textbook, because every patient’s anatomy is different. The more procedures you do, the more you learn. Work hour restrictions threaten surgical training, he added. He fears that we are treading the European path that turned surgical trainees into shift workers and has seriously harmed the doctor-patient relationship.

Dr. Healy advocates a large multicenter study to determine what factors have an impact on residents’ fatigue and burnout, rather than a clumsy reliance on the 80-hour work week.

Dr. Stewart pointed out that for specialties such as otolaryngology-head and neck surgery, excessive work hour restrictions may be overkill. Disagreeing with the IOM report that suggests that ACGME adopt even more restrictions, he said that the rigidity of such limits will gradually have an erosive effect on the culture of medicine. I am very worried that we’ll be losing professionalism in medicine. Where will the role models be for young doctors? My generation of doctors and earlier ones were taught to make personal sacrifices for our patients, but the new message is to be committed to your patients, but go home because an arbitrary limit has been set for you, he said.

IOM’s 12/14/2008 Proposed Additional Changes to Residents’ Duty Hours

• Five-hour protected sleep period
• Increased minimum time off between scheduled shifts
• Four-night maximum on in-hospital night shifts; 48 hours off after three to four nights of consecutive duty
• Increasing from four to five the number of days off per month
• Restricting moonlighting by including internal and external moonlighting hours against the 80-hour cap

Hospitalists’ Blueprint for Non-Resident Services

With ACGME’s 2003 implementation of the 80-hour resident work hour restrictions, academic medical centers were immediately confronted with handling increased inpatient volume as resident availability decreased. Some hospitals responded by creating hospitalist services independent of residents, thereby leaving residents with fewer patients and tasks. While such services usually don’t break even financially, they help hospitals comply with ACGME rules.