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Article: Have Resident Work Hour Restrictions Compromised Training - a Pediatrician’s Perspective Back to article | View all comments

Author: Merlin C. Lowe, MD, FAAP | August 26, 2009

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September 26, 2009 08:35 PM
Merlin C. Lowe, MD, FAAP's avatar

I agree, Dr. Foaud.  At my institution, the restriction in work hours was not met by an increase in resident numbers.  The attending physicians were required to make up deficit.  As such, one of the other trends I am concerned about is that more and more of the responsibilities that residents once carried are being shifted to attendings.  This deals with the deficit in physician presence but, again, pulls more training opportunities from the residents.  Time will tell what ultimately happens but it does behoove us to be cautious as we move forward in this area.

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September 26, 2009 05:29 PM
Tamer M. Fouad, M.D.'s avatar

Thank you Dr. Chan for this comprehensive article. While there are many articles about the effects of resident work hour restrictions on patient care and overall performance, this article touches on a vital aspect of medical care: i.e., training.

If education and training are indeed affected by the new rules then the effects on patient care and overall performance may not be obvious for some time. The presence of well trained senior staff may act as a safety net, mitigating disasters in patient care before they occur. If subsequently, they are replaced by inadequately trained physicians the whole system could possibly collapse.

Increased work hour restrictions leads to increased fragmentation of patient care, as the patient is less likely to be followed up by the same physician. Ironically, such a system requires better trained staff that would be able to work more efficiently under these challenging circumstances. That’s why I would add my voice to yours regarding being cautious about implementing more restrictions before the effects of current restrictions are adequately assessed.

Were the work hour restrictions accompanied by a complementary increase in the number of residencies and residents per hospital? Otherwise, work hour restrictions would mean that patients also experience resident-care restrictions.

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