As we noted when we broke down seven pros and cons of surgeon work-hour restrictions, the biggest question that came out of the new guidelines was, “Is it better to have a well-rested surgeon, or a well-trained one?” According to new research by The Annals of Surgery, young doctors are much more likely to be well-rested than to have as much residency experience as doctors from a generation ago.
Under increased pressure from politicians and sleep experts, the Accreditation Council for Graduate Medical Education instituted some strict work-hour restrictions for all in-hospital residents, including:
- Placing an 80 hours per week cap on all work and elective moonlighting jobs.
- Putting mandatory “free of duty” periods after certain shifts. For example, a resident must have at least eight hours off after a 16-hour shift and at least 14 hours off after a 24-hour shift.
- 1 in 7 days must be devoid of any clinical duties.
Studies have suggested that the new restrictions have resulted in less resident fatigue or burnout, but others believe they prevent trainees from partaking in the multitude of hands-on experiences necessary to prepare them for the rigors of the job. In fact, a recent survey suggested that previous generations of residents usually participated in one surgery a day, while today’s trainees are only involved in two or three operations a week. That means, over the course of the residency period, today’s residents are subjected to hundreds if not thousands of fewer operations than the previous generation. The Annals of Surgery suggests that young surgeons-to-be are missing out on as much as a year’s worth of experience.
Since the work-hour restrictions have gone in place, the number of residents who have failed their oral exam has increased dramatically. About 15 percent failed their oral exam prior to the work-hour restrictions, but that number has jumped to 30 percent according to the most recent data.
“When you take a whole year’s worth of in-hospital experiences out of training, you can’t be surprised that the ‘product’ is not the same,” said Dr. Frank R. Lewis, executive director of the American Board of Surgery.
Dr. Silverman comments
We have an incredible shortage of qualified doctors. There is no quick fix to the problem, either. Older doctors are retiring, oftentimes because they are sick of regulation or because they are bearing the weight of resident work-hour restrictions. If residents aren’t getting enough time on the job, they will be ill-prepared when the spotlight shines. Who has to pick up the slack? The elder, wiser doctor. It’s no wonder more qualified doctors are leaving the system.
Over 30 million more people are expected to come into the system in the coming years. When you decrease the supply and increase the demand, you’ll notice two things. Either the cost for qualified physicians will go up, or the wait time will.
Or both.
Related source: The Annals of Surgery, New York Times