Strict resident work hour limits can lead to "shift worker" mentality

LETTER — Posted Nov. 8, 2010

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Regarding "Residents to work shorter shifts under more supervision" (Article, Oct. 11): The Accreditation Council for Graduate Medical Education recently voted to shorten first-year resident work shifts even more. As a medical school faculty for over 15 years in two different institutions, I was able to observe the deterioration in resident performance associated with "work rules."

The loss of continuity of care associated with the work rules resulted in a paradigm shift from residents viewing themselves as responsible for a particular patient to just being responsible for what happened during the clinic "shift." Residents tended to act less like doctors and more like "shift workers." Had it not been for the faculty who picked up the ball when residents left, patient care would have suffered.

Established private practitioners in several medical and surgical specialties have commented to me that they did not think that recent residency graduates had the same work ethic as residency graduates before the work rules were implemented. The recent graduates asked for things such as "no clinic scheduled on the days after I am scheduled to be on call," but still wanted the same salary as if they had worked the days after call.

I am not advocating that residents be abused by working over 24 hours, but we baby them so much now that they tend to be observers rather than doctors and are not going to be able to function as doctors when they graduate. Once the last generation of physicians without the shift worker mentality retires, patient care will suffer.

Karen Gehrs, MD, Lakeland, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2010/11/08/edlt1108.htm.

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