I think a lot of us who have lived under two systems now have a very different view than what sounds better as a premed.
Agree
As stated in the article, sleep deprivation is unhealthy and dangerous, and using a system that fails to address this is stupid. If residents cannot be fully trained using a system that allows them work in a healthy environment, then extend the length of their residency training. Why assume that the system of the past (long work hours and call) is the ideal, even if it has produced competent physicians? The achievement of quality physician education and safe, healthy physician work practices aren't mutually exclusive. Why prioritize learning over the safety of the physician and his/her patients?
1) I hope you are the first residency class that has to work an extra year or two. Let's see what you say then- doubt you will be sticking to your guns then...
2) You vastly overestimate how dangerous and unhealthy a little lack of sleep is. They don't keep you awake for a week straight. You work overnight and then get most of the next day to sleep and recover. Your sleep debt is the same (and honestly can be lower in the old system)
3) We have no evidence that
a) work hour restrictions will make things safer
b) work hour restrictions will make things more humane (I'd argue the opposite)
c) Residents can't function during the current work hours (or should I say, couldn't function during the old work hours)
Basically the changes were made without any evidence. EBM... apparently a thing of the past. These changes were pushed by the media and people who claimed that fewer hours HAD to make things safer and more humane, mind you without evidence. There is a single study from the Brigham that looks at this but has some pretty big flaws/lack of outcomes (like no difference in patient harm ).
Well I have gone through both systems and my experience does not support the claim that it is safer and more humane. In fact, I would say this made things worse. Our interns were more tierd and got less experience than my class. You have the same amount of work to do during the day, now you have a very finite amount of time to do it in. You always felt like you were fighting the clock. While technically you can work a 16 hour shift, you need 10h until your next shift (which makes teh 16h to 14h shift). Now subtract the 1-2 hours for handoffs and you end up with a 12 hour day to do the same amount of work that was done in a 30 hour shift. Because of these added ineffiiciencies, you need more interns to do the same amount of work.
What I have seen does suffer is elective time and didactics. There is no 'extra' time for conferences since you are racing against the clock. Normally, internship has few electives and the electives are 2nd year. Since it takes more interns to do the same amount of work (and it is near impossible to get funding from the gov't for a larger intern class) the 2nd years have to work more calls/pick up the slack for the interns. This means your elective time 2nd year is vastly limited. Well if you are in internal medicine and applying to fellowship, much of your elective time will come AFTER you have applied to fellowships.
what about the physicians' health? I haven't seen a rebuttal to the accepted notion that sleep deprivation is detrimental to one's immediate and long-term health. Why must this be the price of an adequate training and learning experience? Can't we break out of the closed-minded perspective that anything challenging the old ways is doomed to fail? If those who trained with q2 call and 120 hour weeks have a problem with residents having a better experience in residency than they did because of some sense of pride in the trials and hazing initiations of medicine, then I feel their opinion is shortsighted and lacks a place in modern medicine. If they have concerns about the quality of patient care during residency, it seems apparent to me that this would be very directly improved, or certainly not harmed, by having better rested residents. If they have concerns about the quality of patient care post-residency, then like I said, compensate for the loss of weekly work time by extending the length of training.
So as I posted above, that will be published by Hopkins sometime (don't know when), the hours slept between the old system and the new system were virtually identical. The only difference was that you get like 6 hours of sleep each night with the new system and 8 hours of sleep 2 nights a week 0-2h 1 night a week and 12 one night a week (with the time to sleep 24h if you wanted). The sleep debt was lower in the old system because you had time to catch up.
In all honesty I did 2 systems using the new work hours (night float and a pseudo-call system) and was more tierd after both of them than with a normal system.
Also, the training is better with the old system. You never really know patients someone else admits for you. That actually leads to worse patient care. Add the million handoffs that now take place and you really make no headway in making things safer (if you don't think handoffs cause problems, go down to the ED sometime).
