48 Hour Work Rule Starts August 1

[exPCM]

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48 Hour per week Resident Work Limit starts August 1, 2009 in the UK

From August 2009, a junior doctor will not be able to work more than 48 hours a week, compared with the current limit of 56.
But Professor Roy Pounder, of the Royal College of Physicians, warns it will not be possible to safely implement the change without more doctors.

The Department of Health says the 48-hour-week will be implemented.
Writing in the RCP journal, Clinical Medicine, Professor Pounder says the EWTD will mean all junior doctors working, in effect, eight hours fewer per week - the equivalent of one less shift.

Staffing at night and the weekend is already too lean to make further reductions, so he forecasts the cuts will have to be made in daytime staffing.

Professor Pounder warns this will have a major impact on the training provided to junior doctors, which is delivered during daytime shifts.

But he says the biggest effect will be on patient care.

"One less day in hospital every week means it will be virtually impossible for a junior doctor to watch and learn about the progress of an illness.

"Seeing a patient once or twice before handing over to the next doctor, who then does the same after a short period, means it is difficult to detect a subtle deterioration in a patient's condition."

Reducing doctors' working hours is partially aimed at preventing potentially harmful fatigue.

Mr Ram Moorthy, chairman of the BMA Junior Doctors committee, said: "The Department of Health and NHS have had plenty of time to prepare for the 48-hour week.

"It must not be allowed to compromise the quality of doctors' training, which is a massive concern, or the service the NHS provides."

A spokeswoman for the Department of Health said: "The NHS is planning for all doctors in training to be working a 48-hour week and half already do so."

http://news.bbc.co.uk/2/hi/health/7328448.stm

 

[Coastie]

UK medicine continues to spiral downwards. Wheeeee!

Such is the pathway of socialism...

48 Hour per week Resident Work Limit starts August 1, 2009 in the UK

From August 2009, a junior doctor will not be able to work more than 48 hours a week, compared with the current limit of 56.
But Professor Roy Pounder, of the Royal College of Physicians, warns it will not be possible to safely implement the change without more doctors.

The Department of Health says the 48-hour-week will be implemented.
Writing in the RCP journal, Clinical Medicine, Professor Pounder says the EWTD will mean all junior doctors working, in effect, eight hours fewer per week - the equivalent of one less shift.

Staffing at night and the weekend is already too lean to make further reductions, so he forecasts the cuts will have to be made in daytime staffing.

Professor Pounder warns this will have a major impact on the training provided to junior doctors, which is delivered during daytime shifts.

But he says the biggest effect will be on patient care.

"One less day in hospital every week means it will be virtually impossible for a junior doctor to watch and learn about the progress of an illness.

"Seeing a patient once or twice before handing over to the next doctor, who then does the same after a short period, means it is difficult to detect a subtle deterioration in a patient's condition."

Reducing doctors' working hours is partially aimed at preventing potentially harmful fatigue.

Mr Ram Moorthy, chairman of the BMA Junior Doctors committee, said: "The Department of Health and NHS have had plenty of time to prepare for the 48-hour week.

"It must not be allowed to compromise the quality of doctors' training, which is a massive concern, or the service the NHS provides."

A spokeswoman for the Department of Health said: "The NHS is planning for all doctors in training to be working a 48-hour week and half already do so."

http://news.bbc.co.uk/2/hi/health/7328448.stm

 

[Tigerz_Fan]

And I'm sure the next step will be to extend residency. That's the only way to get the training required....

 

[exPCM]

They cut the weekly hours limit for the UK resident docs to 58 hours in 2004 and then to 56 hours in 2007. They did not extend the residencies when they cut the hours in 2004 and 2007 and I doubt they will extend the residencies this time.
http://news.bbc.co.uk/2/hi/health/3939033.stm

 

[Law2Doc]

And I'm sure the next step will be to extend residency. That's the only way to get the training required....

Not really. I know a UK doctor who said the consensus among his peers is that they come out of residency feeling only about half as trained as their US counterparts, because they spent half as many hours in the hospital. So the learning curve post residency is simply steeper and longer.

 

[Tigerz_Fan]

They cut the weekly hours limit for the UK resident docs to 58 hours in 2004 and then to 56 hours in 2007. They did not extend the residencies when they cut the hours in 2004 and 2007 and I doubt they will extend the residencies this time.
http://news.bbc.co.uk/2/hi/health/3939033.stm

Thanks for the link!

 

[radslooking]

you know, I am for reasonable work hour limitations when appropriate, and this does not seem appropriate. 56 hours? That's like, a light week. To some extent, you just have to be around so you see enough things. 48 hours makes less safe doctors, not more safe.

 

[Law2Doc]

you know, I am for reasonable work hour limitations when appropriate, and this does not seem appropriate. 56 hours? That's like, a light week. To some extent, you just have to be around so you see enough things. 48 hours makes less safe doctors, not more safe.

It's a different culture. People on that side of the pond don't work the long hours, and take longer vacations etc. I've done business deals with folks in Europe and it was constantly frustrating that the window of time that you could actually catch someone at work was so short. So nothing got done, and the US counterparts generated a disproportionate amount of the fees and profits. No reason to expect medicine to be any different, particularly since it's socialized.

 

[Advicer]

What I find interesting is the notion that residents should work horrendously long hours is supported by residents. Will 48 hours work? Perhaps not, but then again 80 hours may not work so well either. Having once been a resident, I still have painful memories of sleep deprivation and barely scraping by financially. From my perspective, socialized medicine doesn't work, although there are those who would argue this point, but neither do 80 hour work weeks, two weeks of vacation and a salary equal to half of what nurses make with a four year degree or less in some instances

What I think a lot of young doctors miss is that rules are not always made for their welfare, but for their patients. To think that you can function well after being up all night is to defy logic.

The other argument that makes little sense is to get on a pedestal and state that by shortening the work day, you will have to extend the number of training years. Certainly, experience is a very valuable teacher, but perhaps what is needed is a new approach. Otherwise, as our knowledge base grows, residencies will need to become longer and longer, and at some point, longer residencies won't be supported.

For those of you who think that Europeans are backward, then go spend some time in Europe. You just might change your mind.

 

[earmuff]

What I find interesting is the notion that residents should work horrendously long hours is supported by residents.

For those of you who think that Europeans are backward, then go spend some time in Europe. You just might change your mind.

Agree with these two statements...

Europe has excellent clinicians and researchers, some of whom are taking the lead in defining the future of medicine.

What we can't learn from others we don't deserve to know.

 

[earmuff]

Not really. I know a UK doctor who said the consensus among his peers is that they come out of residency feeling only about half as trained as their US counterparts, because they spent half as many hours in the hospital. So the learning curve post residency is simply steeper and longer.

n=1

 

[dragonfly99]

I think the 80 hour work week limit was a good thing, in general. I have worked >100 hrs/week as a med student and I don't think after a certain point that you are really learning much of anything...just putting one foot in front of the other, walking around half asleep. I also had a small car accident going home, which I know was related to the fact that I was pretty much asleep at the wheel.

Having said that, 48 hr limit I do not think is wise. I honestly don't think I could have learned nearly as much in IM residency even with a 56 hr work week/limit. As far as inpatient medicine goes, you just have to be there to see the pathology and the progression of disease...then again, a lot of residencies have done away with overnight call anyway, so I'm not sure people are really seeing that anyhow. I personally couldn't really understand how people would learn as much in residencies with total night float, though I think it is probably good for certain rotations to have shorter than 24 hr on call shifts (for example, I think ICU would be better that way and a NEJM study showed that it was safer in the MICU to schedule that way).

I think we should do what works for trainees and for patients. I don't think a 3 year residency working 48 hrs/week could have provided the learning that I got during my IM residency.

 

[xaelia]

If only the 80-hour weeks, spare-no-expense medicine, and all that superior training were making the U.S. healthcare delivery system a higher-quality product compared to all those socialized, under-educated folks across the pond....

 

[Law2Doc]

If only the 80-hour weeks, spare-no-expense medicine, and all that superior training were making the U.S. healthcare delivery system a higher-quality product compared to all those socialized, under-educated folks across the pond....

Apples and oranges. If you like apples better, then apples are better. But just because they are all called doctor doesn't mean a head to head comparison is reasonable. It's a very different system, and I think most agree that the issues with the US healthcare system are not the quality of the doctors. The job descriptions though are very different between the US and overseas, the applicants are very different, both because people spend more time before applying in the US than the straight from high school approach in many other countries, and because US programs strive for diversity, and because the higher incomes tend to draw different segments of the population, and then yes, the training is more hours a week. What patients expect from a US doctor is very different than what patients have grown to expect from a UK doctor. Both do a good job in their respective systems. But I'd suggest the folks who jump from one system to the other, in EITHER direction, will feel less well trained in some aspects of their home education. At least that's the perspective I've gotten from the UK docs I've known who transitioned to the US, who have felt the learning curve was fairly steep. It's mostly the different patient expectations of doctors, their interactions, and what characteristics schools select for, that creates the biggest differences -- everybody learns the same medical text material and can do most of the typical procedures. So I'd say yes, the US healthcare system turns out the product its consumers demand and does a very solid job. No other nation does as good a job of creating what the US consumers demand, and so in that respect it is superior. The same thing probably is true on the other side of the pond - I'm willing to concede that nobody turns out a better physician for the UK environment than a UK school. The devil is in the details here. The 4 years that people broaden their experiences in college here, the kind of individuals selected and self selected here after more opportunity to see them after they have matured (rather than plucked right from high school), the patient service oriented factors, and the longer training hours, all have some benefits for our particular system.

So basically what I'm saying is that by some yardsticks, yes the US is superior. By other yardsticks it might not be. But that is kind of moot because the folks who train in the US and practice in the US only need to be the best for this particular set of consumers located in the US. So it's silly to take the "whose better approach". It's insecure. In the US individuals are selected later, after having an opportunity to see how they do jumping through a variety of hoops and getting to see what they mature into after an additional 4 years of college, which our system sees as superior for its needs to using attrition to pare down to the best and brightest. Then our system values diversity, so many (but not all) folks will end up with a broader liberal arts education before focusing in on the sciences, which our system also values as superior to its needs. And then the training is more intense than most other countries, which our system deems as superior to its needs. Works for us. Others can choose to do differently, but shouldn't kid themselves that their 48 hours is equivalent to 80 hours elsewhere. Different system, different needs, but fewer hours is fewer hours on any continent.

 

[Winged Scapula]

Has everyone forgotten that the residency training scheme in the UK (and most other countries in the EU) is longer than in the US? Everyone spends 2 years post-medical school as an intern and RMO before going onto their specialty training. It is not unusual to meet PGY-11s there.

Not that I think that the reduction to 48 hours isn't worrisome, but you cannot compare 80 hrs/week for 3 years of residency to 48 hrs for 6 years specialist training (using IM as the example).

 

[Doctor Grim]

My cousin is an OB-GYN resident or registrar in Australia for too long-a 6 year training program. I think he works on the avg 40 hrs per week and gets paid extra if he works on weekends. When he is on nights, he's one week on and then one week off. And he gets all kinds of personal vacation time per year where he gets to travel a lot.

I'm not sure how good of a clinician he will be when he gets out comparing to the US counterpart but he is having fun for sure.

 

[sirus_virus]

Where is this notion that U.S trained doctors are better than the ones in the UK coming from? You guys are obviously not reading the statistics on medical errors. Physicians in the Europe are just as competent if not more than their U.S counterparts. Just look at the amount of litigation in the U.S compared to Europe.

 

[mig26x]

Where is this notion that U.S trained doctors are better than the ones in the UK coming from? You guys are obviously not reading the statistics on medical errors. Physicians in the Europe are just as competent if not more than their U.S counterparts. Just look at the amount of litigation in the U.S compared to Europe.

is that because doc in europe are better trained/prepared or does that means that the judicial system in USA is crap or good in europe?

 

[McGillGrad]

Thank you for reminding people of some important facts that most were totally ignorant of while posting their remarks.

Has everyone forgotten that the residency training scheme in the UK (and most other countries in the EU) is longer than in the US? Everyone spends 2 years post-medical school as an intern and RMO before going onto their specialty training. It is not unusual to meet PGY-11s there.
Not that I think that the reduction to 48 hours isn't worrisome, but you cannot compare 80 hrs/week for 3 years of residency to 48 hrs for 6 years specialist training (using IM as the example).

 

[badasshairday]

has everyone forgotten that the residency training scheme in the uk (and most other countries in the eu) is longer than in the us? Everyone spends 2 years post-medical school as an intern and rmo before going onto their specialty training. It is not unusual to meet pgy-11s there.

Not that i think that the reduction to 48 hours isn't worrisome, but you cannot compare 80 hrs/week for 3 years of residency to 48 hrs for 6 years specialist training (using im as the example).

pgy-11!!!!!!!!!! Wow!

 

[Winged Scapula]

is that because doc in europe are better trained/prepared or does that means that the judicial system in USA is crap or good in europe?

Exactly.

Being sued is not a measure of quality. You cannot compare the amount of litigation in the US to that of Europe and make a legitimate conclusion that because fewer Euro physicians are sued that they are somehow better. The two societies and the acceptance of litigation are completely different.

 

[Winged Scapula]

pgy-11!!!!!!!!!! Wow!

Yep. It was not uncommon also for residents to "repeat" years or not be advanced to the next level if the consultants thought they weren't ready. There is no automatic progresssion to being an attending/"consultant" like there is in the US (as long as you perform adequately).

Sounds reasonable until you realize the subjectivity inherent in the practice. One ortho resident I knew somehow managed to piss off his department chair and ended up staying a couple extra years.

 

[tno77]

Shave off 10 hours a week in terms of unneccessary "save my ass" paperwork, finding nurses/technicians, waiting for reports/consults from attendings

that brings the actual "work" week to 60-70 depending on the institution

Hospitals in the US need to become more efficient and residencies need to maximize the learning and working of their residents instead of being bogged down in time-wasting activities

at the end of the day it contributes to LOS for patients and costs $$$$ for the health care system

 

[superoxide]

UK medicine continues to spiral downwards. Wheeeee!

Such is the pathway of socialism...

🙄

What does a 48 hour week have anything to do with socialism? How is this any different than having the 80 hour work week that was instituted in this country not too long ago? As far as I know the length of residencies in the U.S has not changed since that rule was implemented. No one seems to be shouting "socialism" and U.S. medicine spiraling downwards.

Sigh.

 

[superoxide]

Has everyone forgotten that the residency training scheme in the UK (and most other countries in the EU) is longer than in the US? Everyone spends 2 years post-medical school as an intern and RMO before going onto their specialty training. It is not unusual to meet PGY-11s there.

Not that I think that the reduction to 48 hours isn't worrisome, but you cannot compare 80 hrs/week for 3 years of residency to 48 hrs for 6 years specialist training (using IM as the example).

Thank you for pointing this out.👍

 

[dragonfly99]

I never implied that European residents were not well trained.
I know that they train a long time, esp. in the UK.

However (I think for IM at least) seeing the course of a patient's illness during the admission is pretty important to the learning, and I question whether residents with very limited work hours (like 35-45) would ever get to see that. I have to say that although part of me hated 30 hour calls during residency, I did see a lot of things by being able to admit patients and see the course of their illness overnight...

Of course residents cannot stay in the hospital all the time and have to go home and sleep, have some amount of life outside the hospital, etc. The question is what is a good balance and how to we achieve that? I think 48 hr would drastically change the training system that we have, and would be much different than the 80hr/week limit, which I think we needed.

I also don't think it is practical to extend residency much in the U.S., unless we start paying residents significantly more or we make med school cost less, neither of which I see happening soon.

 

[Paddington]

There's no residency in the UK, or at least there didn't used to be. It's a military like system where lots of chumps work at different ranks in a pyramid like scheme. The bottom end is staffed heavily by foreign docs who come for 3-4 years and then leave, unlike FMG's who come to the U.S. with the intent of staying. Not everybody makes it to the rank of "consultant", which is equivalent to an attending in the U.S. A lot of people spend their whole careers as middle grade registrar doctors.

 

[radslooking]

well, if they are spending two years extra (even one year extra) that is going to mitigate somewhat the work hour restrictions. One or two years more experience is a lot. I can say that for myself, I would have performed better with a longer program with shorter hours.

 

[scab]

Shave off 10 hours a week in terms of unneccessary "save my ass" paperwork, finding nurses/technicians, waiting for reports/consults from attendings

that brings the actual "work" week to 60-70 depending on the institution

Hospitals in the US need to become more efficient and residencies need to maximize the learning and working of their residents instead of being bogged down in time-wasting activities

at the end of the day it contributes to LOS for patients and costs $$$$ for the health care system

Efficiency is the key here. Papaerwork is seemingly endless!

 

[dacrocytic]

Not really. I know a UK doctor who said the consensus among his peers is that they come out of residency feeling only about half as trained as their US counterparts, because they spent half as many hours in the hospital. So the learning curve post residency is simply steeper and longer.

this would imply the UK doctors were competing with their US counterparts? for residency spots perhaps?

is it fair to say the US residents were able to learn more because they made more mistakes due to lack of sleep?

if so would this type of learning be necessarily better?

 

[TTPHUS]

Not really. I know a UK doctor who said the consensus among his peers is that they come out of residency feeling only about half as trained as their US counterparts, because they spent half as many hours in the hospital. So the learning curve post residency is simply steeper and longer.

yeah ..and NPs ( accordind to their movement ) are still more qualified than these british docs ...why even do residency ...be a dnp 🙄