Resident Restructure: Attendings adjust to new work-hour rules

“Upper level residents need experience with extended shifts and extended duty hours,” he added. “After residency, in practice, there are no restrictions.”

Poor Preparation

John Sinacori, MD, FACS, director of the otolaryngology residency training program at Eastern Virginia Medical School in Norfolk, said that residents need to be taught the realities of the duty hours expected post-residency and added that the new ACGME rules are a setback to that preparation. He said his 10 fellowship-trained attendings are already discussing the potential impacts of decreased workloads for PGY-1 students and added requirements for supervision. (See “New Rules 101.”)

The burden of supervision and clinical work is not expected to be as great on otolaryngology faculty as it is on other educators, particularly those in internal medicine. Dr. Sinacori, however, fears that educators who are overburdened with non-teaching duties may begin to feel that the extra requirements are taking time away from the work that drew them to academic medicine in the first place.

“We have a very young group, we have a passion for teaching,” he said. “But already I hear these frustrations.”

Dr. Sinacori said the 16-hour limit, while well-intentioned in the vein of patient safety, is somewhat arbitrary in that it “magically” jumps to 24 hours on the day residents start their second year of training; the 24-hour limit remains in place for all subsequent years.

He suggested that a 16-hour shift could be a useful transition period for PGY-1s, but that the adjustment from medical school to residency schedules should take no longer than a month, maybe two. He added that the limit on duty hours does not address patient safety directly because residents are not guaranteed to take a nap or rest quietly once their shortened shift is complete.

“We cannot ensure that the tired resident is going home and resting before starting their next shift,” Dr. Sinacori said.

In fact, the reduced workload leaves residents less prepared as they enter their second and subsequent years, said Christine Franzese, MD, FAAOA, associate professor and residency program director of otolaryngology and communicative sciences, at the University of Mississippi Medical Center in Jackson, Miss. Dr. Franzese, as chair of the Society of University Otolaryngologists-Otolaryngology Program Directors Organization (SUO-OPDO), was on a panel discussing the new duty hours at the group’s annual meeting in October.