Monday, August 8, 2011

No more sleepy doctors?

Photo: Sleepless and Tired
Yesterday's New York Times Magazine had an article on the new ACGME residency work hour rules written by a pediatric cardiologist. I think it presents a balanced view of the the topic and it interests me for several reasons. I recall several scary episodes from my own sleep-deprived residency days, including giving nurses verbal orders in my sleep, but I was luckier than one of my colleagues who demolished his car after a night on call. As a hospital epidemiologist, my interest in the new rules revolves around whether there will be any impact on medical errors, which the article points out is still open for debate. As a medical educator, I'm also interested in the impact on medical education, which the article does not address. Will the decreased hours and the associated decrease in clinical experience lead to less competent doctors? And the rules have also impacted the work environment in the hospital, a topic I addressed in an essay published last year. While I favor the rules and strongly support having well-rested doctors, I do worry about the adverse unintended consequences.

1 comment:

  1. Among the other ripple effects of the new hour rules, many academic medical centers are hiring hospitalists by the score to run “staff only” medical services, to make up for reduced resident presence on the units (the alternative--to expand programs and bring in more housestaff--is not realistic for most internal medicine programs). This changes the culture on our units (I don't know if it is for better or worse, it's just different). For example, at Iowa the new hospitalist-run service replaced our “Team D”, which was the service attended by subspecialty services, including infectious diseases. So suddenly there are no ID docs attending on the general medicine service at our main teaching hospital (all of our assignments are now at the VA). I’ve appealed to change this, and have been told it will be changed, but for this year our ID faculty who attend on general medicine will only be at our VA. I’m sensitive to this, because I’m quite sure that my own decision to go into ID was driven by my gen med attendings during residency at the University of Virginia. One of my first attendings was Edward W. Hook, Jr. (an emeritus at that time), followed over the next 3 years by a long line of great clinician educators (e.g. Brian Wispelwey, Mike Scheld, Mike Rein, Gerry Donowitz, Fred Hayden, Gerald Mandell). To attract the next generation of ID docs and hospital epidemiologists, we need to have a presence on our major resident teaching services(full disclosure: ever since I became a practicing clinical microbiologist and started splitting my time between Medicine and Pathology, I myself have dropped out of the gen med attending rotation!).