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

September 29 • 1:21 PM

Conference Call: Free Will Conference


September 29 • 12:00 PM

How Copyright Law Protects Art From Criticism

A case for allowing the copyright on Gone With the Wind to expire.


September 29 • 10:00 AM

Should We Be Told Who Funds Political Attack Ads?

On the value of campaign finance disclosure.


September 29 • 8:00 AM

Searching for a Man Named Penis

A quest to track down a real Penis proves difficult.


September 29 • 6:00 AM

Why Do So Many People Watch HGTV?

The same reason so many people watch NCIS or Law and Order: It’s all a procedural.


September 29 • 4:00 AM

The Link Between Depression and Terrorism

A new study from the United Kingdom finds a connection between depression and radicalization.


September 26 • 4:00 PM

Fast Track to a Spill?

Oil pipeline projects across America are speeding forward without environmental review.


September 26 • 2:00 PM

Why Liberals Love the Disease Theory of Addiction, by a Liberal Who Hates It

The disease model is convenient to liberals because it spares them having to say negative things about poor communities. But this conception of addiction harms the very people we wish to help.


September 26 • 1:21 PM

Race, Trust, and Split-Second Judgments


September 26 • 9:47 AM

Dopamine Might Be Behind Impulsive Behavior

A monkey study suggests the brain chemical makes what’s new and different more attractive.


September 26 • 8:00 AM

A Letter Becomes a Book Becomes a Play

Sarah Ruhl’s Dear Elizabeth: A Play in Letters From Elizabeth Bishop to Robert Lowell and Back Again takes 900 pages of correspondence between the two poets and turns them into an on-stage performance.


September 26 • 7:00 AM

Sonic Hedgehog, DICER, and the Problem With Naming Genes

Wait, why is there a Pokemon gene?


September 26 • 6:00 AM

Sounds Like the Blues

At a music-licensing firm, any situation can become nostalgic, romantic, or adventurous, given the right background sounds.


September 26 • 5:00 AM

The Dark Side of Empathy

New research finds the much-lauded feeling of identification with another person’s emotions can lead to unwarranted aggressive behavior.



September 25 • 4:00 PM

Forging a New Path: Working to Build the Perfect Wildlife Corridor

When it comes to designing wildlife corridors, our most brilliant analytical minds are still no match for Mother Nature. But we’re getting there.


September 25 • 2:00 PM

Fashion as a Inescapable Institution

Like it or not, fashion is an institution because we can no longer feasibly make our own clothes.


September 25 • 12:00 PM

The Fake Birth Mothers Who Bilk Couples Out of Their Cash by Promising Future Babies

Another group that’s especially vulnerable to scams and fraud is that made up of those who are desperate to adopt a child.


September 25 • 10:03 AM

The Way We QuickType


September 25 • 10:00 AM

There’s a Name for Why You Feel Obligated to Upgrade All of Your Furniture to Match

And it’s called the Diderot effect.


September 25 • 9:19 AM

School Counselors Do More Than You’d Think

Adding just one counselor to a school has an enormous impact on discipline and test scores, according to a new study.


September 25 • 9:05 AM

Sponsors: Coming to a Sports Jersey Near You

And really, it’s not that big of a deal.


September 25 • 8:00 AM

The Most Pointless Ferry in Maryland

Most of the some 200 ferries that operate in the United States serve a specific, essential purpose—but not the one that runs across the Tred Avon River.


September 25 • 7:00 AM

Hating Happiness

People all over the world are afraid of happiness, and that’s not necessarily a bad thing. It’s yet another challenge to the notion that positive thinking can heal all wounds.


September 25 • 6:00 AM

Why I’m No Longer Willing to Give My Money to the NRA

I grew up with guns—as a kid and during my 20-year military career—and support individual ownership rights, but the National Rifle Association’s platform has shifted radically in recent years.


Follow us


Dopamine Might Be Behind Impulsive Behavior

A monkey study suggests the brain chemical makes what's new and different more attractive.

School Counselors Do More Than You’d Think

Adding just one counselor to a school has an enormous impact on discipline and test scores, according to a new study.

How a Second Language Trains Your Brain for Math

Second languages strengthen the brain's executive control circuits, with benefits beyond words.

Would You Rather Go Blind or Lose Your Mind?

Americans consistently fear blindness, but how they compare it to other ailments varies across racial lines.

On the Hunt for Fake Facebook Likes

A new study finds ways to uncover Facebook Like farms.

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.