Five years later, adjusting to the 80-hour week

In July 2003, when the national council overseeing medical education limited residents’ work hours to no more than 80 per week, medical school faculty and hospital staff around the country saw the intervention as a mixed blessing [See “Recreating the Residency,” Fall/Winter 2004]. On the one hand, the Accreditation Council for Graduate Medical Education was responding to public fears that overworked residents might make poor medical decisions; on the other hand, fewer hours on duty carry the risk of less continuity of care.

At the School of Medicine, balancing these two concerns has called for flexibility. “We’ve had to adapt continually, and we’re still adapting,” said Rosemarie L. Fisher, M.D., HS ’75, associate dean for graduate medical education. Peter N. Herbert, M.D. ’67, chief of staff and senior vice president for medical affairs at Yale-New Haven Hospital, acknowledged that sticking to an 80-hour week has been difficult for some programs, particularly those in intensive care units. The hospital has redistributed the workload by taking on more physician assistants and advanced-practice registered nurses. Still, some faculty and administrators worry that residents may feel obliged to do as much work as before—as much consulting with patients, analyzing as many lab results—in fewer hours. Fisher looks to further fine-tuning of the regulations—for instance, pilot programs that incorporate a mandated rest period—to address this potential problem.

In response to the new work rules, some specialties have created more positions for residents: neurosurgery, for example, has expanded from six residency positions to 12. Even in the midst of a long in-hospital shift, evidence of the new rulings is apparent. Areas have been set aside for residents to rest undisturbed, and such arrangements have “probably worked out better for everyone” than the marathon-like conditions that prevailed earlier, said Herbert. “I think the system as a whole has acclimated very well.”