Tuesday, September 4, 2007

Indignation - Resident Life

When I spoke with the DNB last night, he sounded completely worn out. The tiredness was almost palpable. He was very busy this call series. There is only he and another resident caring for nearly 25 patients, except that she is off call when he is on. In addition, this service is set up with one on-call intern covering not only their own patients, but also the patients of four other busy services. He is lucky to sleep an hour.

The DNB views this chronic exhaustion and other issues which arise during his medical training to be par for the course. He is resigned to his fate - that the next three to seven years will be physically, mentally, and emotionally draining.

I am not resigned. I'm far too indignant, and I need other people to know.

The Accreditation Council for Graduate Medical Education sets standards for resident duty hours. You may remember the enormous stir caused when the ACGME reduced permissible duty hours from 120 each week to 80. Hospitals cried foul, arguing that their costs would spiral out of control if they had to hire additional employees to cover the extra hours. Residency programs insisted that 80 hours a week wasn't enough to ensure quality medical education.

The reasons for the work hour restrictions were many, with patient safety and care being touted as a primary aim. Some emphasis, albeit too little, was placed on the effect of a 120 hour work week on the emotional well-being of the residents themselves, as well as their families.

The results of the limit have been largely inconclusive - patient errors are still made, while residents themselves are still under appreciated, overworked, and generally unable to spend much quality time with their families.

What I know, however, is what I live.

The DNB rarely is able to complete his work within the duty hour restrictions. He regularly is forced to go over, by a staff physician who takes literally the entire day to round on patients, or the burden of caring for far more patients than is reasonable. The theory is that silly young interns like the DNB simply aren't efficient enough and that a more experienced resident would have no trouble with duty hours. The attorney in me says that if this is truly the case, GIVE THE INTERNS LESS WORK instead of blaming them for the shortsightedness of a program which refuses to recognize the steep learning curve of the profession.

Medical education is the high goal of the residency program, and many sins are committed in its name. In at least three years of training, is it truly valid that residents would be woefully unprepared to practice on their own if they worked, say, 60 hours a week instead of 80? When their minds are a fog for the last 10 hours of their 30-hour call shift, what educational benefits are gleaned then? And why do we now allow "education" to take priority over the health and well-being of young people? This is the medical field, of all places. The field that before all others should glory in the benefits of sleep and happiness for its professionals. Care for others, and you cannot care for yourself.

In arguing for longer duty hours, the hospitals did have a point: it would cost them hundreds of thousands of dollars a year to hire staff to replace the now practically lazy residents. This is because residents work for a pittance in the name of education (better only a bit than the thousands of medical students who work only slightly better hours and pay for the privilege). The DNB's take-home pay hovers around $32,000.

At least, I thought when I heard the pay scale, we'll have fantastic medical benefits. The irony floored me. In what is more and more appearing to be a Screw You attitude towards residents, medical premiums for "additional dependents" are outrageous, roughly $560 each month. At $6,720 per year for the premiums alone, we would be left with $25,280 a year to live on. Instead, as the wife of a doctor, I have had to purchase short-term medical insurance to cover me until I begin work. No doubt I would qualify for state health programs.

We did sign up for this - this resident life. But that doesn't make it right. Or easy.

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