Physician Compensation Supply of Medical Services

Match Day

Today is “Match Day.”  The Match Day proceedings will determine not only where graduating students will work after medical school, but also what kind of doctors they will become.  What will work life be like for these students?

If they were to enter a residency 20 years ago, they may have worked 120 hours per week.  Now, however, the Accreditation Council for Graduate Medical Education has placed residents on a strict 80 hour work week.  In fact, the Council is even considering dropping the limit to 60 hours per week.

The Washington Post reports that although most residents appreciated the reduced work hours, physicians fear that resident training may suffer.  “John W. Larsen, 67, GWU’s OB-GYN department chairman, said he worries that reduced hours have diminished new doctors’ training. Residents who stay with one patient from their arrival at the hospital all the way through to delivery have the advantage of detecting and recalling tiny but important clues that might not be written down when a case is handed to the doctor on the next shift.”

Although most residents prefer shorter work hours, in some cases they would actually like to work more.  One first year resident said that “…she usually works 70 to 75 hours a week but sometimes stays beyond her shift to take part in procedures involving fetal abnormalities.”

In the entire article, however, there is no mention of what is best for patients.  Having residents work 120 hours per week instead of 80 hours may (or may not) improve physician training.  However, would you like to be treated by a doctor in the 39th hour of a forty hour shift?  I thought not.   Dr. Larsen also worries that handoffs between one resident and another may not be smooth and shorter hours will increase the number of these transitions.  Why then shouldn’t practicing physician also work longer hours to improve patient care?  Experienced doctors may also want residents to work long hours for another reason: they’re cheap labor.

In the debate between the number of hours residents should work, policymakers should focus on what is in the best interest of the patient rather than subjecting residents to what is, in essence, an elaborate hazing ritual.

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