Residency program directors oppose shorter work day

Medical residents aren't the only ones unhappy with new 16-hour shifts; most (71.6 percent) program directors who manage interns and residents disapprove of the duty-hour limit, according to an article published yesterday in the New England Journal of Medicine.

The 549 program directors largely support the other rules set by the Accreditation Council for Graduate Medical Education (ACGME), including the 80-hour workweek, the maximum frequency of in-house call and mandatory off-duty time, according to a survey taken one year after implementation.

But like residents, they oppose limiting the workday of first-year residents to 16-hour shifts, the article noted.

According to the program directors, the regulations had little effect on resident supervision and patient safety, while the perceived quality of life for residents improved.

Yet many of the respondents reported a worsening for resident education (64.8 percent), preparedness for senior roles (73.2 percent) and accountability for patients (78.6 percent), along with less continuity of care (82 percent). Moreover, the duty-hour regulations led to increased workloads for most program directors, according to the article.

And even though the new regulations aim to curb fatigue, surgical interns are still struggling with burnout, stress and lack of sleep, Mayo Clinic researchers noted in a January study in JAMA Surgery.

Despite such discouraging results, some hospitals are finding success with the new work-hour rules. For instance, Johns Hopkins Bayview Medical Center touts safe handoffs, energized residents and a learning environment that enables studying fewer patients more carefully, MedPage Today reported.

"We've changed our system so people are working more shift work, which is what real doctors actually do. Not too many docs in the real world work 30-hour shifts," Colleen Christmas, M.D., associate professor of medicine and residency program director at Johns Hopkins Bayview, told MedPage.

For more:
- here's the NEJM article
- read the MedPage Today article