The 80-hour experience: What happens when residents have to leave

The jury is still out on whether limits to residents' work hours hurt or help educational training, but the rules are here to stay.

By Myrle Croasdale, AMNews staff. July 25, 2005.

When Jamie Chang, MD, learned that resident work hours were being capped, he was concerned that his education would suffer.

Two years later and now chief resident of internal medicine at the University of North Carolina Hospitals program in Chapel Hill, he considers his training good overall, but he clearly has less time for lectures and less continuity with patients.

"I worry about that a lot -- if resident education is as good as before," Dr. Chang said. "From the standpoint of working on the wards, patient care, that hasn't decreased. Our hospitals have added ancillary personal to help out with that. I don't have objective data, but my gestalt is that attendance at noon conferences is down. I know when the hours were introduced, I personally was unable to make it to as many conferences as before. ... On the whole, though, I think people are coming out quite well."

Two years into resident work-hour reforms, there is little consensus among those in medical education about how the work-hour restrictions are impacting the quality of education. Some experts believe that residents aren't getting the same breadth and depth of experience as those who came before them. Others believe that becoming a competent physician requires focused hours in the hospital, not endless hours in the hospital.

Deborah DeMarco, MD, associate dean for graduate medical education at the University of Massachusetts Medical School, said it's too soon to tell which opinion will prevail.