I'm at the other end of the tunnel - just ready to leave my 5 year residency in medicine and psychiatry.
A few points (okay - many), some of them playing the devil's advocate:
1) Many hospitals have come to depend on the cheap labor that resident's provide. The long hours are not usually because of interest in "educational" opportunity, but more out of requirements for clinical service.
2) I would guess that part of that money going to the residency program is used to write off losses for caring for uninsured patients. I just know that many hospitals are struggling financially, and the last thing they would be excited about would be having to hire more staff to take on the role of residents working less hours, even if it obviously needs to be done. The government would then have to come up with the money to help out these institutions to keep them going - politicians won't be excited about more taxes.
2.5) Longer residency with less hours - would you also take less pay? Who would pay for this extra training time? The taxpayers. I do know people who modified their residency to work every other month so they could spend time with their family. I don't know the details of the financial arrangement though.
3) There are the restrictions in New York, and I did hear that they were mostly ignored. I know the ABIM/ACGME has requirements for medicine residency programs which are being somewhat enforced, as programs are evaluated every few years and can lose accredidation for too many violations.
4) Something to keep in mind is that no one is forced to become a doctor. No one is forced to become a surgery resident, let alone one at a program with a (proud) reputation of a 110% divorce rate. There are options for residency programs that are not so malignant. Each person has to make a choice for their own personality and life-style. You'd be surprised that there are actually people who would hate to only work 70 hours a week.
5) The long hours don't end after residency (for many people). Private practice docs usually see more patients, and often work longer hours than some residents - they make this choice because they like it (or like the money / need it to pay off debt)
6) I have found a lot of my time in residency is now spent on paperwork that was not part of my job 5 years ago. Same is true for the staff. Much of the new medicare billing guidelines are killing medical education. More time on paperwork, less time with patients, teaching, and learning. And now records are less useful to read through than ever.
7) You'd be amazed that even with all of the complaining of being overworked, how many residents manage to find time to moonlight.
8) Good question about someone with needs for regular sleep patterns and whether that would fit under the ADA - I don't know. I have heard of a resident with bipolar disorder and the program allowed him/her to not take night call. I don't know what reasons went into making the decision.
I personally think more resources should be invested into finding economical ways of delivering care that allow for physicians to work more normal hours. Some of this is already being done with physician assistants and nurse practioners. It is not so simple as making a law saying residents can only work an average 80 hours per week and expect the rest of the system to handle it.
Rick
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