No long-term benefits from 80-hour workweek for surgical residents

Regarding "A work in progress: Reshaping residency" (Article, March 13): Your interview with Accreditation Council for Graduate Medical Education Executive Director David C. Leach, MD, on the 80-hour resident workweek was quite interesting.

However, I have some observations that perhaps he does not see. Indeed, patients may be safer from residents who are tired, but I do not think they are going to be safer with practitioners who go through this system. For instance, even when residents are home, those hours count against their 80 hours. Also, it is not too infrequent that during a particular operation residents have to leave.

I wish I could be limited to 80 hours a week. But that is ridiculous, because I take calls at home from my own practice, which of course counts. When these residents enter the work force, they are going to be in for quite a surprise. There needs to be more qualifying about the exact number of hours residents are working. For example, if they are taking calls at home and they do not get any calls, those hours should not be counted.

Many of my surgical colleagues are quite concerned about the lack of overlap when residents are taking call and passing patients off to the next shift and also the fact that residents' experiences are being curtailed surgically. This will be detrimental to future patients when those residents are in practice.

I also think there is a difference between internal medicine residencies and surgical residencies. In surgical residencies, you have the hands-on experience and you have to be in cases that are difficult and sometimes long, i.e., neurosurgical cases, and do not necessarily comply to the clock.

Peter F. Holmes, MD, San Antonio

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/04/24/edlt0424.htm.