Surgeons Decry Latest Duty-Hour Restrictions

Limiting duty shifts for surgical residents will not necessarily hurt the quality of education or increase the number of years of training needed, according to Dr. Czeisler. He pointed out that "surgeons in New Zealand have been training with a 16-hour shift limit since 1985, without needing a longer training program."

Dr. Mark L. Friedell, an ACS Fellow and president of the Association of Program Directors in Surgery, suggested that the fourth year of medical school could be used to prepare students for surgical residency. Dr. Sachdeva said that the ACS is working with other organizations to develop a surgery "boot camp" for fourth-year medical students.

Another helpful alternative would be to develop a "milestone" for first-year residents that might make the ACGME feel comfortable in letting them work 24 consecutive hours, like other residents, said Dr. Friedell, who directs the residency program in general surgery at Orlando Health, a network of hospitals.

Reports from five residency programs on their experience thus far with duty-hour restrictions suggest that surgery interns now are working 6 days/week, and "golden weekends" have disappeared. Patient hand-offs have increased in many programs. Faculty and senior residents are under more stress as more of the workload shifts to them. Many programs have hired additional nurse practitioners and physician assistants to help handle the work residents no longer do.

First-year residents report that they do not feel blamed for the restrictions, but many feel they are being shortchanged by not having the same duty hours as other residents, Dr. Friedell said.

"Part of the reason we're in the mess we're in is because we didn't pay enough attention to what residents did in the pre-80-hour era," said Dr. Joshua M.V. Mammen, assistant professor at the University of Kansas, Kansas City, and past chair of the ACS Resident and Associate Society (RAS). He echoed a theme suggesting that enhanced supervision of residents -- rather than limiting duty hours -- is the key to safe practice.

In a 2006 Internet-based survey of RAS members, approximately 60% said that, ideally, residents should work less than 80 hours/week, and 40% favored more than 80 hours/week, said Dr. Mammen. In an ongoing survey of current RAS members with 841 respondents so far, it's more of a 50-50 split, he said. In all, 48% said that residents should work 60-80 hours/week, 47% believed 61-100 hours/week would be ideal, 2% favored fewer than 60 hours/week, and 3% wanted residents working more than 100 hours/week.

The speakers had no conflicts.