The Doctor Can’t See You Right Now, He’s Nappingby Maria Goddard, MD | December 21, 2008
On December 2nd, the Institute of Medicine (IOM) released a report suggesting that resident physicians have further limits on work hours than those enacted in 2003 by the Accreditation Council for Graduate Medical Education (ACGME). While the number of hours per week would remain at the ACGME maximum of 80, the IOM recommends on 30-hour shifts that a “protected sleep period” of 5 hours occurs between 10pm-8am. These measures are aimed at reducing physician fatigue and the number of resultant medical mistakes.
At face value, this seems like a step in the right direction but what are the wider implications? Many programs in labor intensive specialties such as general surgery argue that the quality of education and training has been compromised by the restrictions. They dispute that patients will be safer if doctors are exposed to fewer cases and clinical contact. There have been difficulties with some programs maintaining the current policy and further restrictions will potentially stretch many training institutions to their limits. The older generation of medical practitioners views long work hours as a rite of passage which they successfully survived. They believe that this helps to develop the strong character and discipline of a physician. Younger doctors however are becoming increasingly focused on job satisfaction and overall quality of life outside of medicine.
One way to address this problem would be to increase the number of residency positions. However, this would require that more funding be available to hospitals for these salaries. In an already overburdened healthcare industry, where will this money come from? In addition, a recent survey by the Physicians’ Foundation showed that there is a reduced interest in primary care practice; even those currently in practice are dissatisfied with their jobs. Many plan to drastically lower the amount of time in practice or to leave the field altogether. Add to this increasing wait times in emergency rooms, the failing economy leading to unemployment and loss of health insurance coverage and the situation appears bleak. In these uncertain times can the public afford for doctors to work less? Many rural areas in states such as Georgia are already concerned over the lack of readily available primary care.
When the new political administration takes over in 2009, it will be interesting to see what direction they take to protect and improve healthcare in America. The citizens of a country are its greatest resource and without adequate access to medical care, the country will not be able to prosper.
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. Institute of Medicine of the National Academies, December 2nd, 2008
The Physicians’ Perspective: Medical Practice in 2008. Survey conducted on behalf of The Physicians’ Foundation by Merritt Hawkins & Associates, October, 2008.
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