uasom doctors uasom doctors - University of Alabama at Birmingham

Feature Stories
Regarding his own concerns about the potential
negative impact of the rule, Boulware notes
that by reducing residents’ on-duty hours,
ACGME has created the need for additional
“patient-care handoffs”—residents having to
hand off patient-care responsibilities to others.
Boulware fears additional handoffs could contribute
to lack of continuity in patient care and
could result in more confusion in the health-care
system. He says this is ironic, since the ACGME
was trying to use this new rule to contribute to a
smoother system.
“I am concerned, too, about what this might
mean down the road regarding public trust in a
health-care system already under fire by the public,”
says Boulware.
Regardless of one’s opinion about the 80-hour
rule, Boulware says, it’s here to stay—at least for
the foreseeable future. “The ACGME planned for
this a long time and it has a reputation for sticking
to its rules.”
Another prediction that the ACGME will hold
fast comes from Marshall M. Urist, M.D., vice chair
of the Department of Surgery and co-director of the
General Surgery Residency Program. “At least where
surgery is concerned, I think arguments to the
ACGME appealing for exceptions are not going to
go very far,” he says. “Although we do know that it
will be possible to increase residents’ on-duty hours
from 80 to 88 in special cases, we also know such an
increase can be made for educational purposes only,
not to accommodate service needs.”
other care we’re ordering for our patients. This is
good in that we need to learn how to have better
communication. Some of us tend to be solitary
thinkers, and while solitary thinking can have
good points, it’s also important to learn to be
great team players. After all, most of us will have
partners with whom we will be communicating
after we go into practice.”
Another positive, says Davis, is the injection of
some balance into doctors’ lives. “Physicians need
to be well-rounded. They don’t need to be trained
as individuals who work all the time. These morerestrictive
duty hours address that.”
Surgery resident Lackey says there is no doubt
that his own family life has benefited from the
new rules. He has more time with his wife and
He is uneasy about the consequences on the
structure of residents’ educational experiences. At
least until residents become accustomed to the
new rule, Boulware says, senior residents often
will spend time supplementing what junior residents
can do for patients within limited duty
hours. In addition, he notes, the new rule poses
challenges in scheduling certain educational experiences
for residents.
Boulware is worried, too, about the long-term
impact the duty-hours changes could have on medical-school
faculty: “Faculty are being impacted in
two ways. Because of fewer resident duty hours,
some faculty who once had residents with them
now do not. Also, fewer resident duty hours result
in additional patient-care responsibilities being
shifted to the faculty. I fear that these impacts could
drive some faculty out of medical education into
private practice, particularly if they already had
been considering private practice as an option.”
Based on his own observations, Urist questions
the validity of linking sleep-deprived residents to
errors in patient care. “I have not observed a big
problem with residents making bad decisions
because they were sleep-deprived,” he says.
Urist adds that he had been concerned about
whether the new rule would permit surgery residents
to take part in the diverse surgery experiences
they need, but he says so far that has
worked out well. On the positive side, he says the
80-hour rule will free residents to explore outsidethe-hospital
learning experiences such as independent
reading.
MORE TIME, MORE QUESTIONS
Residents themselves see some positives about
the rule. Anne B. Davis, M.D., a third-year resident
in internal medicine, says, “Our restricted
duty hours make it even more important that we
as residents become better at communicating
with one another about such issues as tests and
11
In order to hand off patients at the end of
shortened duty hours, residents such as Phillip
Lackey must put an even greater
emphasis on coordination and communication.
two children, and he even can make plans for predictable
weekend time off. At the same time, he
worries about the impact that restricted duty
hours might have on continuity of patient care
and on the quality of training that residents
receive. He wonders, “Will residents receive less
training because the training is less rigorous? Will
they have the skills they need to have?”
Lackey also ponders possible future implications
for residency programs—implications that
are topics of debate throughout the medical profession.
Will the 80-hour rule set the stage for
major changes in the way residents are trained?
Will it in fact help set the stage for residencytraining
periods that will become even longer
than they are today?
As Boulware says, “Only time will tell.”