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Losing Sleep over Residents’ Work Week Restrictions

by Marlene Piturro, PhD, MBA •

Here are the parameters used to structure a non-resident hospitalist program:

  • Set clear goals based on rigorous data analysis.
  • Decide what patient volume must be removed from average daily census to ensure work hours compliance.
  • Gather data on daily variations and trends on inpatient admissions, and peaks/troughs of admissions times.
  • Examine patient volume under different scenarios: removing a fixed number of patients per day, creating intern-admission caps, alternating admissions between residents and hospitalists.
  • Examine call-reduce or eliminate short-call, change the frequency of long-call, or implement limitations on night admissions to house staff.
  • Ponder patient population for the non-resident service: What percentage of low-complexity, non-teaching cases is appropriate?
  • Set average daily census for senior residents (8-10), attendings (9-11), and physician extenders (4-6).

Source: The Hospitalist, Jan/Feb 2005.

The Global Debacle

Since the 1980s, physicians in training outside the United States have been protected from the long hours that promote continuity of care and exposure to surgical and other technical skill practice. New Zealand caps residents’ weekly hours at 72, France at 52.5, and Denmark at 37. In 2009, European countries are expected to implement a 48-hour work week. Work hour restrictions have already cost the EU 1.75 billion euros ($2.38 billion), and left Britain’s NHS alone short 15,000 physicians. A 2002 survey by the British Orthopedic Association concluded: To become a competent surgeon in one-fifth of the time once needed either requires genius, intensive practice, or lower standards. We are not geniuses.

Sir Bernard Ribeiro, former president of the Royal College of Surgeons of England, an outspoken critic of shorter work hours as a deterrent to producing proficiency in the OR, testified before the recent IOM’s Resident Duty Hours Panel to help the United States avoid the same mistakes. Sir Bernard noted that British surgical residents perform 25% fewer procedures than did their predecessors before duty restrictions set in. The IOM turned a deaf ear, claiming that every system is different, and it’s hard to generalize, according to committee member Dr. Kenneth Ludmerer, Professor of Medicine and History at Washington University in St. Louis.

©2009 The Triological Society