Comments on: $1.6 billion to let physicians sleep more http://trueslant.com/turimcnamee/2009/06/12/16-billion-to-let-physicians-sleep-more/ Footnotes for a healthcare system in need of annotation Thu, 03 Feb 2011 15:59:48 -0500 http://wordpress.org/?v=2.9.2 hourly 1 By: Turi McNamee http://trueslant.com/turimcnamee/2009/06/12/16-billion-to-let-physicians-sleep-more/comment-page-1/#comment-82 Turi McNamee Fri, 12 Jun 2009 21:43:09 +0000 http://trueslant.com/turimcnamee/?p=428#comment-82 No problem, that's what this website is all about. To answer your questions: 1. The new recommendations don't reduce the work hours. They're still at eighty. Although I have heard rumors that some programs encourage under-reporting, it would mean almost guaranteed loss of accreditation if they were found out. Personally, I know of no program director who does this. 2. One difference is that residents are more students than employees, and we have to teach them a hell of a lot in a short period of time. If there were funding, materials, time, staff, and interest available to produce a well-trained physician in forty hours per week, it might be worth looking into. As it stands, however, we're still faced with the challenge of ensuring that we produce well-trained physicians within a certain number of years. 3. These issues are a little bit more complex. During residency we have to make sure the residents understand the burden of responsibility that they bear. Unlike nurses, physicians have a lot more responsibility in determining the overall course of a patient's care. If they're constantly handing patients off to one another, they may not develop the skills necessary to see a patient through from admission to discharge. 4. HIPAA, HIPAA, HIPAA. I couldn't possibly know for sure. Residents are at high risk for all of these things, and I do think that overwork may play a role. I also think staggering rates of student loan debt, starting new families, and relocation (in many cases) play significant roles. No problem, that’s what this website is all about. To answer your questions:
1. The new recommendations don’t reduce the work hours. They’re still at eighty. Although I have heard rumors that some programs encourage under-reporting, it would mean almost guaranteed loss of accreditation if they were found out. Personally, I know of no program director who does this.
2. One difference is that residents are more students than employees, and we have to teach them a hell of a lot in a short period of time. If there were funding, materials, time, staff, and interest available to produce a well-trained physician in forty hours per week, it might be worth looking into. As it stands, however, we’re still faced with the challenge of ensuring that we produce well-trained physicians within a certain number of years.
3. These issues are a little bit more complex. During residency we have to make sure the residents understand the burden of responsibility that they bear. Unlike nurses, physicians have a lot more responsibility in determining the overall course of a patient’s care. If they’re constantly handing patients off to one another, they may not develop the skills necessary to see a patient through from admission to discharge.
4. HIPAA, HIPAA, HIPAA. I couldn’t possibly know for sure. Residents are at high risk for all of these things, and I do think that overwork may play a role. I also think staggering rates of student loan debt, starting new families, and relocation (in many cases) play significant roles.

]]> By: brianmoore http://trueslant.com/turimcnamee/2009/06/12/16-billion-to-let-physicians-sleep-more/comment-page-1/#comment-81 brianmoore Fri, 12 Jun 2009 21:07:35 +0000 http://trueslant.com/turimcnamee/?p=428#comment-81 A few questions: - Given that you are a residency program director opposing a reduction in the amount of hours worked, to what extent to you think residency programs encourage their employees to under-report their hours, so as to comply with the 80-hour-a-week restrictions? - What is different about the field of medicine that requires a 80 hour workweek making life-altering decisions, when the vast majority of other employees around the country make far less important decisions for only 33-40 hours, given the medical research into the effect of even mild sleep deprivation on decision making abilities? - How is "continuity of care" and "the physician’s sense of responsibility to his or her patients" related to the number of hours that a physician works, in contrast to nurses, who work fixed shifts while also having to maintain these features? - What percentage of residents at your program currently a) use medication to treat depression b) abuse alcohol or c) have sought therapy? Given that national rates of these characteristics for residents are much higher than the norm, to what extent do you believe these traits are caused by overwork? Pardon the difficult-to-conceal "slant" to these questions. A few questions:

- Given that you are a residency program director opposing a reduction in the amount of hours worked, to what extent to you think residency programs encourage their employees to under-report their hours, so as to comply with the 80-hour-a-week restrictions?

- What is different about the field of medicine that requires a 80 hour workweek making life-altering decisions, when the vast majority of other employees around the country make far less important decisions for only 33-40 hours, given the medical research into the effect of even mild sleep deprivation on decision making abilities?

- How is “continuity of care” and “the physician’s sense of responsibility to his or her patients” related to the number of hours that a physician works, in contrast to nurses, who work fixed shifts while also having to maintain these features?

- What percentage of residents at your program currently a) use medication to treat depression b) abuse alcohol or c) have sought therapy? Given that national rates of these characteristics for residents are much higher than the norm, to what extent do you believe these traits are caused by overwork?

Pardon the difficult-to-conceal “slant” to these questions.

]]> By: Turi McNamee http://trueslant.com/turimcnamee/2009/06/12/16-billion-to-let-physicians-sleep-more/comment-page-1/#comment-80 Turi McNamee Fri, 12 Jun 2009 19:33:38 +0000 http://trueslant.com/turimcnamee/?p=428#comment-80 Great question, Brian. I'd agree that there's an element of that at play. Before the duty hour restrictions, resident hours truly were appalling. Some of us who went through residency at that time do, I think, get a little miffed at the whole duty hours thing. But I'm actually not opposed to the duty hours as they stand. What I take issue with is the huge outlay of dollars for changes that may not make any difference, and may in fact erode the physician's sense of responsibility to his or her patients. Great question, Brian. I’d agree that there’s an element of that at play. Before the duty hour restrictions, resident hours truly were appalling. Some of us who went through residency at that time do, I think, get a little miffed at the whole duty hours thing. But I’m actually not opposed to the duty hours as they stand. What I take issue with is the huge outlay of dollars for changes that may not make any difference, and may in fact erode the physician’s sense of responsibility to his or her patients.

]]> By: Brian In NYC http://trueslant.com/turimcnamee/2009/06/12/16-billion-to-let-physicians-sleep-more/comment-page-1/#comment-79 Brian In NYC Fri, 12 Jun 2009 18:04:16 +0000 http://trueslant.com/turimcnamee/?p=428#comment-79 Question for you Turi, I have a cousin who I'm pretty close with, she's an OBGYN here in NYC. We've discussed the issue of resident's work schedule in the past. Frankly I think it's appalling, she feels it makes for better doctors. I really think her attitude is based on "I did it, why shouldn't they?" Don't you think there is a lot of this at play on this issue? Question for you Turi, I have a cousin who I’m pretty close with, she’s an OBGYN here in NYC. We’ve discussed the issue of resident’s work schedule in the past. Frankly I think it’s appalling, she feels it makes for better doctors. I really think her attitude is based on “I did it, why shouldn’t they?” Don’t you think there is a lot of this at play on this issue?

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