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All in a day's work: The harried life of a medical resident

Residents at New York's Montefiore Medical Center balance furthering their education and providing patient care within the constraints of rules limiting their work hours.

By Jay Greene, amednews staff. Oct. 8, 2001.

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On this day in late August, Stephen Cha, MD, arrives at Montefiore Medical Center at 8 a.m., fresh from seven hours sleep. For the next 20 hours, Dr. Cha, a second-year internal medicine resident, steadily works through morning rounds, chart reviews, patient care and ED admitting duties. Also mixed in are frequent consultations and meetings with fellow residents, attendings, medical students, support staff and patients.

"The hours I work are more than I expected, but the patients here require an immense amount of work, and it is sometimes hard to get it all done before your shift is up," said Dr. Cha, 28, a third-generation physician.

While the beginning of his day went smoothly, the afternoon and evening were frustrating because everything he wanted to do for his patients took longer than anticipated. Dr. Cha spent three hours getting a methadone prescription for a new patient. Another patient refused to take his medication, and it was well into the evening before he was able to get the four patients he admitted from the ED fully settled into their rooms. At 10:30 p.m., almost 11 hours after he ate lunch, he had time to eat dinner.

Dr. Cha does his best to cram as much education and patient care into his shifts at Montefiore as possible. That's because the number of hours he and the other residents at the Bronx, N.Y., hospital work are governed by the state of New York. It is the only state in the country that regulates resident work hours, supervision and ancillary support services. New York's laws were crafted in response to the 1984 death of 18-year-old Libby Zion -- an accident partly attributed to overtired residents. Dr. Cha said the state's regulations help encourage hospitals to develop schedules that keep him and dozens of other residents from working past the point of exhaustion. [...]