Limiting Physician-in-training hours

As someone who has been thru this very process, I'd like to make a few comments. My residency program had 8 interns, 7 second year residents, and 8 senior residents.

People get sick 24 hours a day. So someone needs to be there, fresh and awake to treat them. In my program, the 2nd year residents worked in the ER, and the interns and senior residents worked the rest of the hospital. The hospital was a 650+ bed facility. As an intern, I was responsible for ALL after-hours codes (in case you don't know what that means, it's when someone stops breathing or their heart stops and CPR, IV medications, intubations, etc., are done). There were probably 3 or 4 a night, since our hospital has close to 150 ICU beds. These people were sick. The interns also were responsible for obstetrical care after hours; we also had to answer calls from any other part of the hospital.

Our "call" period was from 5pm to 8 am. With 8 of us, that means every 8th night. Plus, when it was a weekend, we were in the hospital from 8a-8a Sat or Sunday.

In addition to our hospital work, we staffed our clinic from 8am-5pm during the week. Each resident would be in clinic 3-4 days from 8-5. On days we weren't in clinic, we were rotating with different specialists in their offices, following them to the hospital, etc. We would spend approx. 6 weeks each with cardiologists, pulmonologist, rheumatologist, orthopedic surgeons, general surgeons, pediatricians, and psychiatrist.

Also, from 8-5pm, there was one resident in the ER (2nd year); one to cover obstetrics (intern); one to cover pediatrics (2nd year), one for the ICU (intern) and one for the regular, adult patients (intern).

Now, we had to be in clinic, so we could treat our patients when they needed us. We had to rotate with the specialists to learn more expertise. We had to staff the hospital at nights.

How do you expect all this to be done, if residents are limited to only a limited numbers of hours "on the clock?" Remember, I was in clinic all day (8-5), and then worked at night (5p-8a). If I then have to go home to sleep (which believe me, I really wanted to do), who would cover my clinic time, or time with the specialist?

Remember, just to staff the hospital, we need 5 physicians available every M-F from 8a-5p. We need 3 physicians every night from 5p-8a. On Sat and Sun, we were lucky-only needed 3 docs for a full 24 hours. The second year doctor is all tied up in our very busy ER (45,000 patients last year). The intern is running back and forth from the ICU to the OB delivery suite. The senior resident is working everywhere.

Then we need 5-8 docs to be in clinic every day from 8a-5p.

Is the answer to double the number of residents? Some problems with that. 1. Training residents is extremely expensive. Their salaries, malpractice insurance, training time in ACLS, CPR, etc. 2. There aren't enough people wanting to be physicians to double the slots. They'd never fill.

Is the answer to make them work shorter hours? Sounds good, until you realize that there are still 24 hours in a day. If Dr X. can only work 12 hours a day, we need 2 people for that day instead of one. That also means that Dr X. will have to work 7 days a week, with no days off (I guess we could just go home after our shift, pass out in bed, wake up 12 hours later and go back to work- who needs time off, anyway). If we let Dr X. work for 24 hrs at a time, at least it can go home, sleep for 8 hours, and then have a productive day with their family, shopping, mowing the lawn, etc.

Is the answer to just close the program down to new patients after a certain time of day? Don't think that'll fly.
A final thing to think about. When the docs-in-training graduate from their residency program, what are they going to do in their private practices if they were in clinic all day, had to spend all night in the hospital treating their patients, and then have to have clinic the next day? Do you think their patients will mind if they get a Call at 8am stating "Dr X was up all night at the hospital, so he's decided that he's too tired to see you. We need to reschedule. And since Dr X is in solo practice in a small town, she now is responsible to her patients 24 hours a day, 7 days a week. Won't matter to the law firm of Dewie, Cheetim and Howe that Dr X was sleepy, she should have responded faster to Mrs. Johnson's phone call.