Menus Subscribe Search

Follow us


surgeon-training

(PHOTO: NUT IAMSUPASIT/SHUTTERSTOCK)

When Hospital Regulations Go Too Far

• May 28, 2013 • 6:00 AM

(PHOTO: NUT IAMSUPASIT/SHUTTERSTOCK)

A survey of surgical residents found that limiting work hours not only compromises education but leads to worse care for patients.

Most surgeons-in-training dislike new rules that limit how many hours they can work, according to a new study that also found the majority said they skirt the restrictions.

Researchers surveyed 1,013 surgical residents—who train for years alongside more senior surgeons—and found that about two of every three said they disapproved of the 2011 regulations, which aimed to improve patient care as well as the residents’ education and quality of life.

“I don’t think anybody wants to work 120 hours a week, but I don’t think we really want medicine to necessarily have bankers’ hours,” said Dr. Brian Drolet, the study’s lead author and a fourth-year surgical resident at Rhode Island Hospital in Providence.

Under pressure from the public and government officials, in July 2011 the Accreditation Council for Graduate Medical Education (ACGME) restricted the shifts of the most junior trainee surgeons, first-year surgical interns, to 16 hours and capped the shifts of the remaining residents at 28 hours. The regulations built on similar restrictions the organization put in place in 2003, but the policy has raised questions about whether simply restricting the hours doctors-in-training are permitted to work improves their lives or the health of their patients.

About half of the residents said their work schedules were worse after the change and about 22 percent said they were getting less rest despite the limits on work hours.

Some recent studies have suggested, for example, that the new rules create more hand-offs of patient care, and possibly more errors, while shortchanging the doctors’ education.

For the new study, Drolet and his colleagues surveyed residents from graduate programs across the U.S. at the end of 2011, six months after the regulations went into effect. Of the 4,140 residents sent the survey, about a quarter answered the 20 questions about patient care and residents’ education and quality of life. More than half said that patient safety was unchanged six months after the regulations were put in place. About 40 percent said patient care got worse, however, and about 10 percent said it improved.

As for their own education, about 40 percent of residents said there was no decrease in quality, but another 55 percent said it had gotten worse. About 70 percent also said there was less focus on preparing them to take on a more senior role. The same proportion also felt senior residents had to take on tasks more suited for a less-experienced resident.

About half of the residents said their work schedules were worse after the change and about 22 percent said they were getting less rest despite the limits on work hours.

Overall, there was some improvement in the quality of life of first-year interns, but a much smaller improvement among more senior residents, according to the researchers who published their findings in JAMA Surgery.

The most striking of the results, according to Drolet, is that almost 70 percent of the residents said they were not following the new requirement in some way. About half of the residents said they were underreporting or working between one and five hours more than they should each week, and more than 60 percent said they were falsifying their duty hours “to appear in compliance with regulations.”

In a critique accompanying the new study, Dr. Orlando Kirton said the findings on underreporting and falsifying duty hours represent “extremely troubling behavior.” “The ACGME rules are the law of the land. It is no longer about adoption but about adaptation and demonstrating resolve. Non-compliance is not an option and must not be encouraged,” Kirton writes.

He points out, however, that the study had some limitations, including that only a fraction of the hospitals asked to participate in the survey did so.

But Dr. Sanjay Desai, director of the residency program at The Johns Hopkins Hospital in Baltimore, told Reuters Health he believes the researchers would find similar results if they did the study today. “It takes time for programs to adapt to the new rules,” said Desai, who was not involved in the new study. “This just adds to the body of data that I think creates this need to look at this very carefully, partner with everybody concerned to get to the table and look at this more rigorously,” he added.

Andrew Seaman

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

October 24 • 4:00 PM

We Need to Normalize Drug Use in Our Society

After the disastrous misconceptions of the 20th century, we’re returning to the idea that drugs are an ordinary part of life experience and no more cause addiction than do other behaviors. This is rational and welcome.


October 24 • 2:00 PM

A Letter to the Next Attorney General: Fix Presidential Pardons

More than two years ago, a series showed that white applicants were far more likely to receive clemency than comparable applicants who were black. Since then, the government has spent hundreds of thousands of dollars on a study, but the pardons system remains unchanged.


October 24 • 12:00 PM

What Makes You So Smart, Middle School Math Teacher?

Noah Davis talks to Vern Williams about what makes middle school—yes, middle school—so great.


October 24 • 10:00 AM

Why DNA Is One of Humanity’s Greatest Inventions

How we’ve co-opted our genetic material to change our world.


October 24 • 8:00 AM

What Do Clowns Think of Clowns?

Three major players weigh in on the current state of the clown.


October 24 • 7:13 AM

There Is No Surge in Illegal Immigration

The overall rate of illegal immigration has actually decreased significantly in the last 10 years. The time is ripe for immigration reform.


October 24 • 6:15 AM

Politicians Really Aren’t Better Decision Makers

Politicians took part in a classic choice experiment but failed to do better than the rest of us.


October 24 • 5:00 AM

Why We Gossip: It’s Really All About Ourselves

New research from the Netherlands finds stories we hear about others help us determine how we’re doing.


October 24 • 2:00 AM

Congratulations, Your City Is Dying!

Don’t take population numbers at face value.


October 23 • 4:00 PM

Of Course Marijuana Addiction Exists

The polarized legalization debate leads to exaggerated claims and denials about pot’s potential harms. The truth lies somewhere in between.


October 23 • 2:00 PM

American Companies Are Getting Way Too Cozy With the National Security Agency

Newly released documents describe “contractual relationships” between the NSA and U.S. companies, as well as undercover operatives.


October 23 • 12:00 PM

The Man Who’s Quantifying New York City

Noah Davis talks to the proprietor of I Quant NY. His methodology: a little something called “addition.”


October 23 • 11:02 AM

Earliest High-Altitude Settlements Found in Peru

Discovery suggests humans adapted to high altitude faster than previously thought.


October 23 • 10:00 AM

The Psychology of Bribery and Corruption

An FBI agent offered up confidential information about a political operative’s enemy in exchange for cash—and they both got caught. What were they thinking?


October 23 • 8:00 AM

Ebola News Gives Me a Guilty Thrill. Am I Crazy?

What it means to feel a little excited about the prospect of a horrific event.


October 23 • 7:04 AM

Why Don’t Men Read Romance Novels?

A lot of men just don’t read fiction, and if they do, structural misogyny drives them away from the genre.


October 23 • 6:00 AM

Why Do Americans Pray?

It depends on how you ask.


October 23 • 4:00 AM

Musicians Are Better Multitaskers

New research from Canada finds trained musicians more efficiently switch from one mental task to another.


October 22 • 4:00 PM

The Last Thing the Women’s Movement Needs Is a Heroic Male Takeover

Is the United Nations’ #HeForShe campaign helping feminism?


October 22 • 2:00 PM

Turning Public Education Into Private Profits

Baker Mitchell is a politically connected North Carolina businessman who celebrates the power of the free market. Every year, millions of public education dollars flow through Mitchell’s chain of four non-profit charter schools to for-profit companies he controls.


October 22 • 12:00 PM

Will the End of a Tax Loophole Kill Off Irish Business and Force Google and Apple to Pay Up?

U.S. technology giants have constructed international offices in Dublin in order to take advantage of favorable tax policies that are now changing. But Ireland might have enough other draws to keep them there even when costs climb.


October 22 • 10:00 AM

Veterans in the Ivory Tower

Why there aren’t enough veterans at America’s top schools—and what some people are trying to do to change that.


October 22 • 8:00 AM

Our Language Prejudices Don’t Make No Sense

We should embrace the fact that there’s no single recipe for English. Making fun of people for replacing “ask” with “aks,” or for frequently using double negatives just makes you look like the unsophisticated one.


October 22 • 7:04 AM

My Politicians Are Better Looking Than Yours

A new study finds we judge the cover by the book—or at least the party.


October 22 • 6:00 AM

How We Form Our Routines

Whether it’s a morning cup of coffee or a glass of warm milk before bed, we all have our habitual processions. The way they become engrained, though, varies from person to person.


Follow us


Politicians Really Aren’t Better Decision Makers

Politicians took part in a classic choice experiment but failed to do better than the rest of us.

Earliest High-Altitude Settlements Found in Peru

Discovery suggests humans adapted to high altitude faster than previously thought.

My Politicians Are Better Looking Than Yours

A new study finds we judge the cover by the book—or at least the party.

That Cigarette Would Make a Great Water Filter

Clean out the ashtray, add some aluminum oxide, and you've (almost) got yourself a low-cost way to remove arsenic from drinking water.

Love and Hate in Israel and Palestine

Psychologists find that parties to a conflict think they're motivated by love while their enemies are motivated by hate.

The Big One

One company, Amazon, controls 67 percent of the e-book market in the United States—down from 90 percent five years ago. September/October 2014 new-big-one-5

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.