Surgeons: Employees or Professionals?
Available from: rwjf.org
- "In editorials, surgeons have written about their particular concerns regarding this shift-worker mentality, that the eighty-hour workweek was " the antithesis of a profession " (Fischer 2005), that it took away ownership of work and personal responsibility (Botta 2003), and that it threatened to break surgeons' particular bond with their patients (Fischer, Healy, and Britt 2009). Pories observed that " we have diminished a profession that took great pride in total devotion to patient care to one where the time clock rules whether to finish a task, the patient be damned " (2004, 515). "
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ABSTRACT: Medical educators worry that the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty-hour rules (DHR) have encouraged a "shift work" mentality among residents and eroded their professionalism by forcing them either to abandon patients when they have worked for eighty hours or lie about the number of hours worked. In this qualitative study, we explore how medical and surgical residents perceive and respond to DHR by examining the "local" organizational culture in which their work is embedded.
In 2008, we conducted three months of ethnographic observation of internal medicine and general surgery residents as they went about their everyday work in two hospitals affiliated with the same training program, as well as in-depth interviews with seventeen residents. Field notes and interview transcripts were analyzed for perceptions and behaviors in regard to beginning and leaving work, reporting duty hours, and expressing opinions about DHR.
The respondents did not exhibit a "shift work" mentality in relation to their work. We found that residents: (1) occasionally stay in the hospital in order to complete patient care tasks even when, according to the clock, they are required to leave, because the organizational culture stresses performing work thoroughly, (2) do not blindly embrace noncompliance with DHR but are thoughtful about the tradeoffs inherent in the regulations, and (3) express nuanced and complex reasons for erroneously reporting duty hours, suggesting that reporting hours worked is not a simple issue of lying or truth telling.
Concerns about DHR and the erosion of resident professionalism resulting from the development of a "shift work" mentality likely have been overstated. Instead, the influence of DHR on professionalism is more complex than the conventional wisdom suggests and requires additional assessment.
Available from: Charles Czeisler
- "Despite these differences in work hour limits, academic medical communities on both sides of the Atlantic have engaged in similar debate regarding the potential merits and problems of work hour reduction [5-26]. Critics of work hour reduction cite concerns about the costs of replacement providers, workforce sufficiency, disrupted continuity of care and resident physicians' training experiences [8,27]. Conversely, supporters of reform cite the hazards of extended shifts, which have been shown to induce performance impairment comparable to an increased blood alcohol concentration [28,29], and increase the risk of failures of attention, serious medical errors, fatigue-related preventable adverse events, percutaneous injuries and motor vehicle crashes [2,3,30-35]. "
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ABSTRACT: In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue.
We conducted a national survey of 1,200 representative members of the public via random digit telephone dialing in order to describe US public opinion on resident physician work hour regulation, particularly with reference to the IOM recommendations.
Respondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h) and 58.3-h work weeks (95% CI 57.3 to 59.3 h). They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h) and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h), with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%). A total of 81% (95% CI 79% to 84%) believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71%) favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with > or =5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83%) would then want a different doctor.
The American public overwhelmingly favors discontinuation of the 30-h shifts without protected sleep routinely worked by US resident physicians and strongly supports implementation of restrictions on resident physician work hours that are as strict, or stricter, than those proposed by the IOM. Strong support exists to restrict resident physicians' work to 16 or fewer consecutive hours, similar to current limits in New Zealand, the UK and the rest of Europe.
Available from: ejcts.oxfordjournals.org
- "Work should be treated as work and learning as learning. If we do not create a framework of our professional (and not employée ) activity, somebody else will do that. Do not forget—there is a long queue of those, who are willing to work under the rules of the bean counters at the price of the safety of the patients and goodwill of the profession. "
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