Do medical doctors based in the U.S. really need to work crazy hours (80-120+) per week for several years during residency to be effective doctors? originally appeared on Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world.
Answer by David Chan, MD from UCLA, Stanford oncology fellowship, on Quora:
As someone who personally went through residency during a time when work hours were not restricted, and who has taught medical students and residents with hour restrictions, I believe that the current era of hour restrictions for residents has negatively affected physician training. They are less prepared to be effective doctors upon graduation.
If the goal is to have well-rested residents, restricted hours actually don’t seem to make a difference. Studies show that residents tend to sleep short hours even when working much shorter shifts.
If the goal is to reduce medical errors, studies show that shorter hours don’t accomplish that. There are as many serious errors today related to the handoff of sick patients to doctors who are not immediately up to speed. When I trained, it was considered very bad form to leave the hospital if your patient(s) was not stable. Sometimes that meant that you were working through the second day after having worked the first day and all through the night. It wasn’t unheard of to sign out your patients at 10 pm on the second day if your patient was critically ill. As a medical resident, we were routinely up every third night without a day off. The surgeons were routinely up every other night.
If the goal of a residency program is to graduate highly functioning physicians who can take care of seriously ill patients without supervising professors, shorter work hours definitely impact that.
If the goal of residency is prepare doctors to work accurately and professionally when tired, when under pressure or even if mildly ill, shorter work hours impact that also.
Book learning and using Up To Date is no substitute for experience under pressure. Today’s surgery residents are graduating with far fewer cases than before the hour restrictions. Some surgical programs have had to extend the residency to allow the residents to qualify for their boards.
Twenty-five years ago, the general surgery residency at UCLA was five years. Now it’s eight years. In part this was done to encourage “research” but it’s clear that they also need the extra time to get their cases in.
If you ask a surgeon, would they prefer to have a five year residency and work their butts off and qualify for the boards in five years as a highly competent graduate or have a slower pace over eight years and graduate with less experience? The large majority would opt for the shorter harder program and being ready for launch upon graduation.
Graduating residents are not as ready to go today as in previous decades. There is no substitute for experience. I know it sounds like the “when I was young I walked five miles barefoot through the snow to get to the hospital” kind of talk, but being under fire, being primarily responsible for patient outcomes no matter if tired or sick or having personal problems at home, translate into high functioning graduating residents. I think that patients accept no less.
Better to experience physical and emotional stress under the supervision of professors in the teaching hospitals than trying to sink and swim later when there isn’t help around after graduation.
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