New Duty-Hour Restrictions for Interns—Better?

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For those of us in academic medicine, late June is a very significant time of year because it is when medical interns arrive for orientation. In my pediatrics department, these interns report for their first day of work as pediatricians-in-training on July 1. This year, with new duty-hour restrictions going into effect, program directors are a bit more apprehensive about the arrival of their interns. The new restrictions prohibit interns from working more than 16 hours continuously. This essentially eliminates the overnight call experience and creates the concept of shift work for our newest doctors.

Duty-hour restrictions first came on the scene nationally a few years ago in order to make medical training safer for patients and doctors. Physicians who trained during the pre–duty-hour restriction era could view the seemingly endless days and nights in the hospital as a necessary and privileged opportunity to learn or as a physical and mental strain that only set the stage for patient and resident endangerment—or as both (depending on which rotation was considered). I bet some of today’s residents are tired of hearing us old-timers frequently share (brag about) our experiences of excessive hours on duty. I would not be surprised if they tuned out whenever they heard a sentence begin with “Well, when I was a resident …”

I recently met a very accomplished family medicine physician who trained a couple of decades ago. She had originally aspired to be a pediatrician but changed course during her residency. When asked why she left the great field of pediatrics, she responded “I left pediatrics because of the 4 months of every-other-night NICU call during my internship.” In this instance, excessive duty hours were to blame for losing a potentially great pediatrician to another field. I think most would agree that 4 months of every-other-night call is excessive, but it is certainly not unusual. There is a culture in medical training that working numerous hours is the way it has to be, but is it? When I spoke of this with a non-medical friend of mine, she could not comprehend at all why it took so long to place restrictions on residents’ training hours. To her, this seemed to be common sense.

It is very difficult to understand the training process unless one has experienced it. I don’t know whether 16-hour shifts are going to be long enough for interns to learn all that is expected during their first year of training. When the time one has to learn all there is to learn is decreased, should the amount that one is expected to learn be decreased? The results of board scores, patient satisfaction surveys, and patient safety surveys will let us know whether today’s training (under the new restrictions) is as effective as and safer than the old. Pediatricians in all phases of their careers are encouraged to comment on this topic.