The ACGME is the regulatory body for residency programs, and there are rumors that they will change the work hour limits for next year's incoming residents. The concern is that extended periods of time without sleep put patients at risk. Furthermore, the ACGME is starting to differentiate between first year residents (interns) and senior residents. The proposed change is that interns will be limited to 16 hour shifts. This will effectively change all of internship into shift work such as day teams and night teams with an overlap of an hour or two for patient handoff. Many other limits remain the same: 80 hours a week, one day off a week.
I'm not sure I like this. If the ACGME sets this rule, there's no negotiation, but in my opinion, shift work will take something away from inpatient medicine. There really is something tremendously gratifying and enormously weighty about coming into a 30 hour call, getting very sick patients during the daytime, stabilizing them through night, and going home satisfied the following day. That marathon of a day is what bonds me to my patients and what teaches me real medicine. That being said, many services work well with day and night shift work. For example, I thought shift work was perfect for labor and delivery; the main reason for admission to the hospital ("I'm having a baby") is generally straightforward so the patient handoffs between the day and night teams aren't difficult. Furthermore, patients appreciate similar faces each day and night. It's harder for patients to understand the concept of "call."
It seems as though we will move to the 16 hour rule and shift work, and programs are really trying to address that. At UCSF, one hospital is running both the traditional system alongside a proposed system for next year to iron out problems. At Stanford, committees are forming to figure out staffing needs. Hospitals as a whole may need to find resources to hire more hospitalists or nocturnists (staff physicians at night) and programs need to figure out how to maintain educational didactics when some residents will be on during the daytime and some at night. Lots of change will happen within the next few years.
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In ancient Greece, the asclepion was a healing temple dedicated to Asclepius, the God of Medicine. Asclepius learned the art of surgery from the centaur Chiron and had the ability to raise the dead. The Rod of Asclepius is a roughhewn branch entwined with a single serpent.
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Hi! I am Craig Chen, a third year resident physician in anesthesiology at Stanford Hospitals and Clinics. I went to medical school at the University of California, San Francisco. Prior to medical school, I studied philosophy and biology at Stanford University, along with a minor in creative writing.
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