By: The Generation Y Surgeon (@GenYSurgeon)
Using the Duty Hours as a Weapon Part 1 of 2:
Gaming The System
I have a huge beef with most physicians’ interpretations of professionalism. I’ve been called unprofessional for wearing the wrong thing, defending the wrong side of an argument, taking a stand against the majority or doing poorly on an exam–that’s probably all par for the course in surgical residency at what I call “yelling programs”. Like other trainees, I may have been accused of many things, but I am NOT unprofessional. Fun to tell stories of crazy accusations tossed at us as residents over a glass of wine or a beer–but NOT fun for much else. A profession, by a great definition I found and hold dear, is a self-regulated, autonomous group with a shared skill set and body of knowledge. I have many opinions on how surgeons (and physicians in general) should and should not interpret (and display) professionalism. Of course, an issue that seems to be in direct conflict with these guidelines is the issue of duty hour compliance.
Setting The Stage For A Charged Discussion On Duty Hours
Unless you’re brain dead you’ve heard plenty about resident duty hours. No doubt it was negative in nature. The hours were instituted as a means to protect patients and providers alike (well residents anyways–our attendings are still working horrendous and frequently unsafe numbers of hours). Yes, you may feel that the hours restrictions were in response to minimal data and maximum sensationalism whether you admit that publicly or not. However, one thing we may agree on is that there have been many unintended consequences. One example of these unintended consequences is when residents use the duty hours restrictions as a weapon against their program directors, attendings, and even their own co-residents to get what they want–what I call “duty hours as a weapon”.
Do You Realize How Much 80 Hours Is?
Let me preface this discussion with a few realities:
1. Eighty hours is a really long time. It’s twice what most people work in a week.
2. It’s normal to want to work less and go home.
The problem is not with the hours themselves, but how the restrictions are twisted to be self-serving. Violation of duty hour regulations carries stiff consequences including probation and closure of your program! Yet, knowing this, residents continue to gamble with these hours as a means to getting time off or to get out of work.
As A Chief Resident I Have To Fight The Duty Hour War…Against Other Residents!
As a senior resident I find myself in the middle of the duty hour war. As team leaders, senior residents are responsible for educating the juniors on the rules and mitigating the work schedules along with ensuring adequate case coverage and resident availability. I mean, who else would do it? Not the attendings or program administration. They basically say “Guys you need to take care of this!” The hellfire rains down from the program director when violations are logged, yet the most painful battle is dealing with junior residents who “fight” with the hours as a weapon.
Here’s How The Weapon Gets Used
Listen, residents have learned to play the duty hours to maximize their time off and ensure they have time to do what they please. I understand wanting to leave on time, to have a predictable schedule, to go home to your family/gym/friends/etc, but I don’t understand why residents do so in such a non-constructive way. There have been too many times where an unfavorable call or rounding schedule has been met with threats to log violations. It’s infuriating and makes no sense! If we all log violations in duty hour restrictions then we may find ourselves with way too much time on our hands while we try to find another program at which to train! This threat is maladaptive to say the least and instead of being a legitimate issue it’s now just a study in brinksmanship.
Why Do Hours Get Used As A Weapon?
Why do residents do this? Well I think we may not be tired enough. Idle hands are the devil’s tools. (And yes, I think if the intern is writing a page long note then we probably aren’t busy enough.) In the “olden days,” prior to hours restrictions, residents worked such long hours that they just succumbed to the torture and forgot what it was like to be “free”. Some feel they were trained to literally do what we do now “in their sleep” and that they really were “residents” of the hospital. Right or wrong? I don’t know. And of course I think most who completed training “the old way” have Stockholm syndrome.
Maybe Now They’re Rested Enough To Have Some Fight In Them
Today, although we still work twice as many hours as most, we are rested enough to realize that there’s more to life than just residency…and we want to go live it. Pair that with the lifestyle-based decision-making typical of Millenials and you get a group of residents who are willing to do anything to get out of the hospital.
Stop Using The Hours As A Weapon And Be A Professional
Residents, we need to find a better way to protect our time and maintain our professional standards. Using the hours as a weapon is unacceptable. Part of being a professional is learning how to be a self-sustaining and self-governed association….not a self destructive one. Maybe you feel that we shouldn’t bother being a profession anymore, because sometimes it seems like we no longer regulate ourselves but others regulate us. Maybe, but that’s another entry. The focus here is on the fact that duty hour restrictions are here to stay so it’s up to us to use them as a safety measure, not as a weapon…it’s part of becoming as much of a professional as we can be in the current healthcare system.
Disagree? I’m interested to hear what you think. Write me beneath in the comments field.