The Doctor Is Still In: Many Resident Physicians Routinely Work More Than 100 Hours a Week. Are Long Hours a Necessary Rite of Passage or an Obsolete Practice That Endangers Patients? (Employee Relations)

Pomeroy, Ann, HRMagazine

Before Risa Moriarty resigned her plastic surgery residency two-and-a-half years into a seven-year program at Johns Hopkins Hospital in Baltimore, she was routinely working 110-130 hours per week, and sometimes worked a 60-hour shift.

That's three days and two nights on call in the hospital with no sleep other than brief, catch-as-catch-can naps. "It takes an altered state of mind to get through it." she says. "Residency turns you into a very efficient machine.

"I stayed longer than I should have," says Moriarty, now an executive at HealthCite Inc. in Baltimore. "It was a difficult decision to make and one that I spent a lot of time thinking about. I considered changing to another specialty, but I was just completely burned out."

Moriarty says she is not alone in her reaction to the relentlessly long work hours in some hospitals. She believes many physicians are bitter, even the older ones. "After I resigned, two attending physicians called me and said they were envious of my decision.

'Clinical Clerks'

The practice of medicine has changed dramatically during the last century. But the residency and intern system has changed very little since the legendary Dr. William Osler initiated this method of training newly minted doctors at Johns Hopkins University more than 100 years ago.

Osler was a pedagogical innovator who brought students out of the classroom and onto hospital wards as "clinical clerks." These first residents lived a monastic existence, actually residing in the hospital, and were paid no salary.

Today's residents receive a salary and benefits, but still may feel as if they live at the hospital. Work hours Exceeding 100 per week are not uncommon, and 36-hour shifts often are routine. Sleep-deprived residents-the least experienced physicians-are likely to be the first doctors to examine a patient in a hospital emergency room. And today's patients often are sicker even as they spend less time in the hospital than in years past.

Why do doctors persist in continuing such onerous and dangerous training and staffing practices?

"Medicine is a militaristic culture," says Moriarty. "It's a hierarchical, macho fraternity, and hospitals hide behind the argument that doctors know best."

Older doctors who went through the same rite of passage may believe that it weeds out those who don't have "the right stuff." However, Moriarty points out that modern-day residents probably are seeing 50 to 60 patients in a 100-hour workweek--versus 20 in 1950--and the patients present a significantly more complex workload than in the past.

Because of today's longer lifespans, patients are more likely to be older and have multiple illnesses. And medical advances have created an exponentially greater number of potential diagnostic tests, test results requiring interpretation and follow-up treatment …

Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: The Doctor Is Still In: Many Resident Physicians Routinely Work More Than 100 Hours a Week. Are Long Hours a Necessary Rite of Passage or an Obsolete Practice That Endangers Patients? (Employee Relations). Contributors: Pomeroy, Ann - Author. Magazine title: HRMagazine. Volume: 47. Issue: 2 Publication date: February 2002. Page number: 37+. © 1999 Society for Human Resource Management. COPYRIGHT 2002 Gale Group.

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