Residency training in the United States has historically been a period of abusive hours and intense training. Until recently, there was no limit to the number of hours per week a resident could work. In fact, that has something to do with why they’re called “residents” in the first place: they practically lived in the hospitals in which they worked.

Then came the Libby Zion case, in which a young woman died while under the care of overtired residents. Suddenly America realized that it probably wasn’t a good idea to have inexperienced doctors taking care of really sick people on less than three hours of sleep per night. Enter the Accreditation Council for Graduate Medical Education (ACGME) which is charged with accrediting residency programs nationwide. As of 2003, the ACGME limited the number of hours a resident could work per week to 80, 88 if you were training to be a surgeon and then only under extenuating circumstances. If you were listening carefully at that time, you may have heard the cries of outrage from practicing physicians across the country. How could residents possibly learn enough in 80 hours a week? And after all, if we had to do it, then so should they!

As it turns out, however, caps on resident working hours were nothing new, having been in place across the Atlantic for quite some time. In the United Kingdom, for example, the resident work week is capped at 56 hours per week. And as of August 1, 2009, it’s dropping to 48.

As a program director, I believe I can provide my residents with the training that they need in 80 hours per week over the course of three years. 56 hours per week would take some very creative scheduling. But if I were limited to 48 hours per week, I don’t think that adequate training would be possible, at least not in three years. The British Medical Association seems to realize that and has written a paper outlining several options to address this problem, including extended training. Most options, however, entail added staff and costs. Moreover, most practicing physicians work more than 48 hours per week, according to a 2003 JAMA article. Any resident trained in a 48 hour work week environment would be in for a rude awakening once released into the “real world”.

Fortunately, I don’t have to worry about a foreshortened resident work week just yet. But if the ACGME is taking any cues from the training of British physicians, I may be in for a rude awakening myself in a few years.

References

Maintaining the quality of training in the craft specialties: managing EWTD implementation. British Medical Association. 2009.

E. Ray Dorsey, David Jarjoura, & Gregory W. Rutecki (2003). Influence of Controllable Lifestyle on Recent Trends in Specialty Choice by US Medical Students. JAMA, 290 (9), 1173-1178