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

December 20 • 10:28 AM

Flare-Ups

Are my emotions making me ill?


December 19 • 4:00 PM

How a Drug Policy Reform Organization Thinks of the Children

This valuable, newly updated resource for parents is based in the real world.


December 19 • 2:00 PM

Where Did the Ouija Board Come From?

It wasn’t just a toy.


December 19 • 12:00 PM

Social Scientists Can Do More to Eradicate Racial Oppression

Using our knowledge of social systems, all social scientists—black or white, race scholar or not—have an opportunity to challenge white privilege.


December 19 • 10:17 AM

How Scientists Contribute to Bad Science Reporting

By not taking university press officers and research press releases seriously, scientists are often complicit in the media falsehoods they so often deride.


December 19 • 10:00 AM

Pentecostalism in West Africa: A Boon or Barrier to Disease?

How has Ghana stayed Ebola-free despite being at high risk for infection? A look at their American-style Pentecostalism, a religion that threatens to do more harm than good.


December 19 • 8:00 AM

Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.


December 19 • 6:12 AM

All That ‘Call of Duty’ With Your Friends Has Not Made You a More Violent Person

But all that solo Call of Duty has.


December 19 • 4:00 AM

Food for Thought: WIC Works

New research finds participation in the federal WIC program, which subsidizes healthy foods for young children, is linked with stronger cognitive development and higher test scores.


December 18 • 4:00 PM

How I Navigated Life as a Newly Sober Mom

Saying “no” to my kids was harder than saying “no” to alcohol. But for their sake and mine, I had to learn to put myself first sometimes.


December 18 • 2:00 PM

Women in Apocalyptic Fiction Shaving Their Armpits

Because our interest in realism apparently only goes so far.


December 18 • 12:00 PM

The Paradox of Choice, 10 Years Later

Paul Hiebert talks to psychologist Barry Schwartz about how modern trends—social media, FOMO, customer review sites—fit in with arguments he made a decade ago in his highly influential book, The Paradox of Choice: Why More Is Less.


December 18 • 10:00 AM

What It’s Like to Spend a Few Hours in the Church of Scientology

Wrestling with thetans, attempting to unlock a memory bank, and a personality test seemingly aimed at people with depression. This is Scientology’s “dissemination drill” for potential new members.


December 18 • 8:00 AM

Gendering #BlackLivesMatter: A Feminist Perspective

Black men are stereotyped as violent, while black women are rendered invisible. Here’s why the gendering of black lives matters.


December 18 • 7:06 AM

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.


December 18 • 6:00 AM

The Very Weak and Complicated Links Between Mental Illness and Gun Violence

Vanderbilt University’s Jonathan Metzl and Kenneth MacLeish address our anxieties and correct our assumptions.


December 18 • 4:00 AM

Should Movies Be Rated RD for Reckless Driving?

A new study finds a link between watching films featuring reckless driving and engaging in similar behavior years later.


December 17 • 4:00 PM

How to Run a Drug Dealing Network in Prison

People tend not to hear about the prison drug dealing operations that succeed. Substance.com asks a veteran of the game to explain his system.


December 17 • 2:00 PM

Gender Segregation of Toys Is on the Rise

Charting the use of “toys for boys” and “toys for girls” in American English.


December 17 • 12:41 PM

Why the College Football Playoff Is Terrible But Better Than Before

The sample size is still embarrassingly small, but at least there’s less room for the availability cascade.


December 17 • 11:06 AM

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.


December 17 • 10:37 AM

A Public Lynching in Sproul Plaza

When photographs of lynching victims showed up on a hallowed site of democracy in action, a provocation was issued—but to whom, by whom, and why?


December 17 • 8:00 AM

What Was the Job?

This was the year the job broke, the year we accepted a re-interpretation of its fundamental bargain and bought in to the push to get us to all work for ourselves rather than each other.


December 17 • 6:00 AM

White Kids Will Be Kids

Even the “good” kids—bound for college, upwardly mobile—sometimes break the law. The difference? They don’t have much to fear. A professor of race and social movements reflects on her teenage years and faces some uncomfortable realities.



Follow us


Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.

The Hidden Psychology of the Home Ref

That old myth of home field bias isn’t a myth at all; it’s a statistical fact.

The Big One

One in two United States senators and two in five House members who left office between 1998 and 2004 became lobbyists. November/December 2014

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