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Student Rounds: Resident Life By Dawn Mesa As previously reported in the Summer 2003 issue of the Alabama Medical Alumni Bulletin, and in this issue on page 10, the Accreditation Council for Graduate Medical Education (ACGME) has set new rules regarding the maximum number of hours residents can now work per week. The rules, which went into effect on July 1, 2003, limit residents to no more than 80 work hours per week and no more than 30 consecutive work hours at a stretch. In addition, residents must be given one day out of seven free from all clinical and educational responsibilities, they cannot be scheduled for in-house call more than once every three nights, they should be given at least 10 hours for rest and personal activities between daily duty periods and after in-house call, and in-house moonlighting counts toward the weekly limit. All limits are averaged over four weeks. To see how the new rules are affecting resident life at the UASOM, the Alabama Medical Alumni Bulletin asked three current residents about their experiences in light of these changes and their opinions about what the changes have meant for UAB’s hardest-hit specialties: surgery, OB/GYN, and internal medicine. Laurence Rosenberg, M.D., is a fifth-year general-surgery resident; Erika O’Donnell, M.D., is a fourth-year OB/GYN resident; and Elizabeth Turnipseed, M.D., is a first-year internal-medicine resident. What has been the biggest change since the new regulations went into effect? Laurence Rosenberg (LR): I think the biggest difference, overall, is that residents aren’t chronically tired all the time now. Residents are better-rested, they’re able to read and study more. I’m sure there’s not a resident out there from the previous generation who doesn’t have a story about falling asleep at the dinner table or while driving. I know I’ve done that once or twice. EO: We take a lot less calls, which means less experience. I think we’re doing a good job maximizing the calls and experience that we have, but when I was an intern, I was taking nine calls a month. When you compare that to interns now who are taking five or six calls a month, they’re missing out on a lot of experience. ET: I think, for me and for a lot of the interns, the rule that has affected us most is the 30-hour post-call rule. I don’t like to walk out of the hospital feeling like things are unfinished, for a variety of reasons. One, you don’t want to put off what you’re doing on someone else and, two, it’s really hard—especially at my level in learning— to really get a sense of what’s going on if you don’t see something through to fruition. What is the schedule like now for residents in your field? LR: General surgery has a “float” group of residents who take turns in the night rotation. Each resident spends a rotation each year—four to seven weeks—working from 5 p.m. to 7 a.m., Monday till Friday morning; Sunday they then come in at noon and work until 7 a.m. Monday. They continue that pattern and each level is assigned to a team—vascular surgery, general surgery, and so on. There is also a senior-level resident on call for each team, which allows for easier access to these residents, who can help out with certain problems. EO: The OB/GYN schedule is very manageable. We didn’t really change anything with our general service, as far as how many are on it. Things will change next year when the new hospital facility opens and we have an extra person to cover triage. Erika O’Donnell (EO): I think that some of the OB/GYN rotations had higher time requirements than others and the 80-hour restriction impacted those services—oncology and antepartum particularly—more than others. We had to adjust our call schedule and, like surgery, changed our night-float system. It’s working out really well now; when we converted initially it was slightly problematic in terms of coverage issues. Elizabeth Turnipseed (ET): Given that I never worked in the previous environment, I’ve noticed that, in internal medicine, we can rather easily facilitate the 80-hour workweek. The post-call, 30-hour regulation is a little bit more difficult to adhere to and more noticeable. If this system is going to work as it’s intended, it’s got to involve more shared responsibility. What has been the biggest negative since the new regulations went into effect? LR: The biggest negative that most faculty and people complain about is a perceived lack of continuity of care. I don’t necessarily agree with that, though, because prior to the regulation change, residents weren’t on call every night—so they weren’t there all the time to take care of those patients regardless. Erika O’Donnell says the 80-hour workweek has created a more tight-knit group of residents. 18
some nurse clinicians for the different divisions. They help tremendously, and take care of discharges, setting up home health and social services, and answering patient phone calls—this does help out a lot. EO: We cover two hospitals for call: Cooper Green and University. The nightfloat system is in place at University, and then we have people at Cooper Green for a particular rotation who cover most of the call during the week, one night a week, and the general call pool team covers the weekend and Friday. Everyone takes their turn. The biggest change at Cooper Green is that one resident covers there with an attending present at all times, except for Thursdays when there are two people there. We’ve had to have our third-year on night float at University act as a floater at Cooper Green—they’ll help out if it gets busy there. ET: Our department has increased the number of residents that it’s getting every year. I think we increased by five this past year and that we’ll be increasing by five for the next several years. Restricted duty hours give residents more time to rest and catch up on their reading, says Laurence Rosenberg. “We’re here to learn and be educated— that’s the point of residency.” ET: Most of our ward medicine months have a night-float system where some member of the team is on every fourth night and night float comes in to help them, but the other members get to go home. Ultimately, you have to spend every eighth night at the hospital, but the team is on call every fourth. The subspecialty services are a little different. In pulmonary, for instance, there are five of us, but only one member takes call every night. In medicine, at least, we never have call nights more frequently than every fourth night, but then they range from every fourth night to every eighth night. On a personal level, how is your situation now that these limits are in place? LR: It affects the junior-level residents a little more than the senior-level residents, but I am able to read more and I’m not fatigued all the time. I can clearly feel a difference; it allows me to be more communicative and have a more positive attitude. I think that’s a true benefit from the patient’s standpoint. Do you think this system is working out well? LR: I think it works well. Nothing’s perfect, and every situation has problems, but the old way had problems too. I know that, overall, most people are significantly happier in terms of their ability to complete and tolerate five years of a general-surgery residency. EO: As a chief, I’ve been here going on four years now, and I think that our faculty and residents have a great rapport and work together very well. I think the 80-hour workweek has made us a tighter group; we’ve had to rely on each other for coverage, and it’s brought us even closer together. ET: There is still some tweaking to be done, but I think for the most part it’s worked out. From a patient-care perspective, there were a lot of problems with residents being so grossly overworked. We can’t take our education out on the patients that are here for care. How have the new rules affected hospitals that employ residents? LR: In the past, it wouldn’t be uncommon for residents to work 110 to 115 hours a week, and if they can now only work 80 hours a week, that time has to be made up. There was no argument that a lot of the time residents are in the hospital is a waste of their time—they’re not being educated or doing productive things to learn. Instead, they’re doing tasks that in other places are done administratively but, because residents are the cheapest form of labor, the residents have to do them. How have the new rules affected your department? LR: In surgery, either our director—Dr. Kirby Bland—or the hospital has hired With in-house call limited to every fourth night, Elizabeth Turnipseed and fellow residents have more time for family and hobbies. EO: I have a four-and-a-half-month-old daughter, so it’s given me more time at home with my family. I think going home post-call has allowed me to be rested and get some sleep. I think I’m more efficient the next day because I’m not so tired and not taking a ton of calls a month. Being a chief and looking for a job this past year, it’s also allowed me the time needed to interview. ET: It’s definitely been a busy year, but it’s not overwhelming. I do come in early in the morning, but I leave the hospital in time to go home and see my family. I think it’s nice to know that there’s a little bit of predictability to it. Looking at the residency program in general, there are a lot of residents who are married, who have children, who have hobbies—I think that’s a good indicator that it’s working. 19
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Page 3 and 4: ALUMNI ASSOCIATION BOARD OF DIRECTO
Page 5 and 6: News Briefs “SOWING THE SEEDS OF
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Page 9 and 10: Full Speed Ahead: Lonnie Funderburg
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Page 15 and 16: The Big Move Sprinting Toward Compl
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