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“When I Was a Resident”: Duty Hour Rules Do Not Define Me

Recently, Rebecca Ulep wrote a rebuke of recent resident duty hour restrictions and their potential negative effects on physician education in a post entitled “When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians. Many practicing physicians agreed with these sentiments, while most residents did not. Our expanding #PulmCC community brought me  into the acquaintance of one the latter, who agreed to write a post taking the other side of the argument. Scroll down for the article, and hit the link above to read the original post. And follow the #PulmCC hashtag on twitter to keep up with relevant material and participate in future #PulmCC twitter chats. 

I argue with my father a lot. He works as an intensivist at a community hospital in Indianapolis while I am about to graduate from a highly academic internal medicine program in Chicago. Needless to say, we have very different perspectives.

He sometimes expresses views similar to those written in a previous article, “When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians. I started residency the first year that the new intern duty-hour regulations were put into effect. After explaining these rules to my father, he asked me: “How do you guys learn? When I was a resident, we did not have limits to how many patients we saw. I would be working until five or six in the evening on my post-call day and then stay to work a moonlighting shift.” I, then, delightfully asked him if that was before or after penicillin was discovered.

The field of medicine has undergone many changes (yet we still carry pagers…that’s for another rant), some for better and some for worse. There has been much debate over potential benefits and detriments that come with the changes in duty-hour regulations.  I can only speak to the culture at my own institution, but in my experience, there is one thing that has not changed: the pride we take in our work. This is why I take particular issue with the overly dramatized notions brought up in the aforementioned article. Continue reading ““When I Was a Resident”: Duty Hour Rules Do Not Define Me”

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“When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians.

 

This article was written by a Pulmonary, Critical Care Fellow who completed residency after recent resident duty hour restrictions went into effect.

During my internal medicine residency, we were allowed to work  a maximum of 30 hours per shift.  You would do a 24 hour call in the hospital , then round on your patients post-call and go home by noon.  This was the norm.  I completed 5-6 of these shifts per month during my entire 3 years of residency.  Even then, when timidly telling my attending physicians that it was time for me to go home after fulfilling my 30 hours of duty and barely being able to keep my eyes open, they would respond with the old clichéd phrase “Well, when I was a resident……”  The sentence would usually end with something about how they used to work for 3 days straight with no sleep, no shower, and on and on.  Just like your Dad telling you “When I was a kid, I would walk to school, barefoot, in 6 feet of snow…..uphill.” At least that’s what my Dad would say, and I would sigh and roll my eyes.    I never thought I would agree with such a cliché.  But now, as a 2nd year Pulmonary and Critical Care fellow, I frequently find myself repeating these same exact words:  “When I was a resident..” and let’s face it, that was only 2 years ago.

 I completed my residency  prior to the “new” duty hour limitations that went into effect in 2011.  The new regulations limit residents from working more than 16 hours straight; after 16 hours, they must have a mandatory “nap” time.   This has forced many institutions to change the call schedule to so-called “block nights”.  Residents are only allowed to work 12 hours during a call shift.  They work 12 hours and may stay for an additional 1-2 hours after for educational lectures and sign-out, but otherwise, they are off duty.  I have even found that many resident physicians will not even return a page after 7 am because apparently that would be a violation of duty hours.

 Shortening duty hours to a maximum of 16 hours at a time has not, in my opinion, improved resident physicians experience in any surmountable way.  It seems detrimental if anything.  Studies including the one recently published in JAMA, would seem to support the view that shortened hours may not in fact be beneficial to residents or their patients.

Because of the changes in work hours, residents are becoming less educated, less experienced, and more apt to push work off onto someone else or to leave it altogether.  They have a decreasing sense of patient responsibility and motivation.   I frequently hear, “Oh, I have to leave, can’t go over my duty hours,” even when there is still patient care to be done.  I’m not asking that residents be asked to stay beyond what’s reasonable (and I know “reasonable” is still the big debate), but I do think these increased restrictions on allotted time in the hospital are molding a generation of residents who are less than motivated. Many are being  instilling with bad habits and a poor work ethic.

Now, I know, maybe I am just one of those people. The overachiever who expects a lot from myself, and from others.  I am, after all, a pulmonary/critical care fellow, so I do have that type of personality.  But I know the majority of my colleagues agree with me:  the general consensus is that these duty hour restrictions are instilling a lackadaisical apathy in many of the underclassman.  Not all, but many.  We are teaching them that it’s OK to do the minimum, and that there’s not a need to go above and beyond.  It’s OK that you weren’t able to put that arterial line in because you put in your 12 hours, and I know you were busy.

In my opinion, this is not acceptable. Continue reading ““When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians.”