Medical residency hours to be cut back

Television shows like Scrubs and ER have made the harried medical resident -- perpetually sleep-deprived and abused by attending physicians -- into an icon.

However, real residents in the University of Pennsylvania Health System are facing new national guidelines and internal practices that cut back hours and otherwise make residency more livable -- at the possible expense of quality of training.

The Accreditation Council for Graduate Medical Education, the body responsible for setting national standards for residency and fellowship programs, introduced a number of restrictions on working hours in July. These include a cap of 80 work hours per week averaged over four weeks and no more than 30 hours in a row.

In addition, a number of UPHS departments have made internal changes, moving to a shift-based system called "night float." Instead of working on call for 24 hours, residents are relieved in the evening by a night staff.

"The institution of the night float system was created to put less stress on the residents and to improve the quality of resident life," said Michele Cepparulo, education administrator for the Psychiatry Residency Program.

Night float was introduced in 2000 and currently operates in such departments as Medicine, Psychiatry and Surgery.

Partly as a result of the new ACGME guidelines and partly to sustain these internal changes -- all of which mean fewer working hours per resident -- UPHS has spent $6.5 million to hire additional staff, mainly nurse practitioners and other ancillary workers.

The hope is that these changes benefit both residents and patients, improving quality of life and patient safety and care.

"Let's put it this way: Who would want to be seen in the emergency room by a resident who hadn't slept in 36 hours?" said David Musick, associate director of the residency program at the Department of Rehabilitation Medicine.

He added that residency has changed nationwide in recent years as safety concerns have replaced the notion that training should be a rite of passage.

Brian Glatt, chief resident of the Division of Plastic Surgery and president of the Housestaff Committee representing UPHS residents, experienced some of those changes firsthand. He worked 120-hour weeks during the first two years of his surgical residency.

Glatt called the old form of residency "physically demanding, emotionally draining, sometimes very overwhelming."

"It trained you to work in all mindsets," he said. "Do I think it was healthy, though? Probably not."

Although UPHS residents say that the new policy is an improvement, they have some reservations about it. Glatt praised the hiring of additional support staff but expressed the criticism that residents are no longer exposed to as many training situations.

"You're missing -- as silly as it sounds -- getting woken up in the middle of the night to take care of whatever," he said.

General Surgery resident Laura Kruper echoed Glatt's sentiments. The institution of night float two and a half years into her residency affected her personally when she dropped from 120-hour weeks to 90- to 100-hour weeks.

"I think people are happy with the changes for the most part," she said, but "some of our training is suffering a bit."

"Giving an absolute rule of 80 hours a week is not very insightful," Kruper said, adding that a more creative approach would give residents enough rest but allow for greater continuity of patient care.

The residents uniformly described their UPHS experience as stressful but rewarding.

"I think if it was a hand-holding experience that people wouldn't be good doctors," Kruper said.

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