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

HR Magazine, Feb, 2002 by Ann Pomeroy

However, Moriarty remembers living "in a fog" during her residency. She recalls a time when she was operating on a patient and was so sleepy that "I couldn't even talk. I slurred my words like a drunk." (See "Sleep Deprivation and Medical Errors," p. 42).

One State Limits Hours

After a young woman died in Cornell Medical Center's New York Hospital in 1984 as a result of an adverse reaction between two medications ordered by a sleep- deprived medical resident, the woman's father, a reporter, convinced a New York district attorney to begin a grand jury investigation. The jury found neither the hospital nor the physicians at fault, but cited the system that permitted overworked, sleep-deprived residents and a lack of adequate supervision of these residents.

As a result, New York became the only state to pass a law regulating work hours for residents. In 1989, it adopted the "Bell Regulations," named for Dr. Bertrand Bell, who chaired the committee that recommended the regulations.

The regulations mandate that residents work no more than an average of 80 hours per week over any four-week period and no more than 24 consecutive hours. That is still a grueling schedule, of course, but Dr. Diane Hartmann, associate dean of the University of Rochester Medical Center's school of Medicine and Dentistry, says the law has improved resident education. Such hours re manageable and are no uncommon after doctors have finished their training, she rotes.

Another strategy the hospital has implemented--the night float system of teams working in shifts--is not perfect, either, Hartmann says. Rotating shifts "alter the continuity of patient care. A patient may be passed off to three different doctors over a 24-hour period, and you can lose things in the passoff." A "shiftwork mentality" an take hold that can diminish commitment to patients, she says.

New York's regulations have some enforcement teeth, and hospitals can be fined if residents exceed the work limits. State regulators spend a week at each hospital once a year, question residents and attending physicians and impose fines for noncompliance. Hartmann says her hospital does internal reviews twice a year as well because she wants to be ready for the state inspections.

Mary Killackey a fourth-year surgery resident at the University of Rochester Medical Center, says it can be frustrating to be forced to leave the hospital when time limits are reached. Especially in the field of organ transplantation, which she hopes to go into at the end of her general surgery residency, she says a doctor wants to stay with her patient as long as necessary.

The limits mean residents don't see the quantity and variety of patients and situations they would see if they spent more time in the hospital. Killackey says she's worked on too many routine surgeries and too few unusual operations. "If I've seen 100 hernia operations, it's no advantage to me to see 125 such cases."

Nevertheless, Killackey believes there are more pluses than minuses to limiting residents' work hours. "I attended a very academic medical school [Columbia University Medical School], and I'm interested in research. The New York system allows me to do more than just clinical duties."