When Everyday Feels Like Wednesday

For those of you who don't know, the ACGME and RRC began enforcing resident work hour (also called duty hours) limitations in 2003. The highlights are that residents can admit new patients for no longer than 24 hours straight but can continue to work another 6 hours to finish up their work and/or participate in educational activities for a total of no more than 30 consecutive hours worked. The weekly work hour limit is averaged at 80 hrs/wk over a 4 week period with one day off in 7. I got used to the look of horror when I told non-medical people that the new work hours were great, we only had to work 80 hours a week now.

I happened to begin residency in 2003 and was therefore part of the "80 hour workweek" class. Defending ourselves against the onslaught of disdain from our senior residents and attendings became the norm our intern year. We were seen as privileged, lazy, and not concerned about patient care and learning. We, however, didn't know any differently. We were forced to compress our considerable intern workloads into 80 hours a week without the support of faculty members and try to learn how to be a compassionate physician at the same time. Oh, and learn enough pediatric medicine to not look like a buffoon on the wards. Although I championed the benefits of the duty hour regulations, over the course of my 3 year residency I realized its shortcomings as well. It provided an easy cover for those residents who wouldn't have valued educational initiative anyway and evened the playing field between those residents who would not walk away from 'loose ends' and those who had no qualms about doing so on a regular basis. Now we all had to be comfortable signing out work until we could come back in the next morning.

Now as an attending, I see a permutation of the duty hour regulations affecting the residents I currently supervise. They seem to have lost the pride in patient ownership that I remember feeling as an intern. Residents now have been forced to evolve into number crunching, note writing, order entering and work hour tracking doctors in training who actually spend the shortest allotment of their time at the bedside. I am constantly amazed at how much medicine is now practiced in front of a computer screen.

The reason I bring this up is not to play the "when I was a resident" game and disparage those trainees coming up through the ranks. It isn't their fault the duty hour regulations exist, just like it wasn't ours in 2003. But I heard something disturbing the other day. On a listserv to which I subscribe, a post was written about new regulations that will further cut down on the number of hours residents work. In that model, more of the daily work will fall on the attendings so the residents will still have time to attend educational activities as well. I fear that if this keeps happening, a pediatric residency will need to be extended to 4 years from 3. And from what i've been reading, this fear is warranted. However, I fear more the pediatrician who graduates from residency and is adept at studying and attending lectures but has no idea what to do with a difficult family or an acutely ill patient!

This issue will be revisited again and again in this blog in the upcoming year, especially as I transition to an academic pediatric hospitalist position and work with residents and medical students full time. And yes, I did just say that I will be writing this blog for another year. Thanks for your support!