If you want to take the pulse of academic medicine, put your finger on Boston, home to three med schools and an archipelago of teaching hospitals training some 4,000 medical residents.
So this morning’s Boston Globe grabbed our attention with an update on teaching hospitals’ continuing struggle to adapt to four-year-old rules limiting residents’ work hours.
Boston hospitals are hiring more residents, shifting some work to more-experienced doctors and improving patient hand-offs when residents punch out. Preliminary research cited in the story suggests medication errors and other problems may be declining because residents are less fatigued than they used to be. The work limits are 80 hours a week and 24 hours at a stretch, which can be extended to 30 hours in some cases.
Hasan Bazari, who runs Mass General’s internal medicine residency program, explains the dilemma. The new rules “have basically transformed residency from an obstacle course to something that’s actually sustainable and enriching. But at the end of the day we still have the question of what is the right mix of experiences and exposures to train a doctor. And if you cut back work hours, can you still train people in the same period of time?”
Some residents may not be adhering to the rules. While a study by the group that accredits residency programs found that only 3% of residents worked more hours than the rules allowed, Harvard sleep researchers found that 80% of residents they surveyed worked excess hours.