No 9-to-5 Doctors
In reference to Ann Japenga’s article on medical residents’ work schedules (“Endless Days and Sleepless Nights,” March 6), I wish to reassure the public and our patients that the examples given in this article represent one end of a wide spectrum of work hours.
There is no question that the physician-in-training spends far more hours working and on call than is generally accepted for normal work situations. It is important to keep in mind that, in addition to providing patient care services, a physician-in-training is also a student in a graduate medical education program with a specific set of educational goals and guidelines and annual examinations with advanced certification as the ultimate goal. It is frequently difficult to separate the educational aspects from the purely service activities in any specific time period.
As Japenga’s article indicated, surgery and surgical subspecialties, such as obstetrics and gynecology, tend to have more rigorous work hours by the very nature of the specialty and the continuing expansion of medical knowledge and experience necessary to train a practitioner.
The article indicated that a house officer may go for more than a month without a day off. This may indeed be the worst-case scenario, which infrequently occurs in the first postgraduate year. These physicians may be on every-other-night call for some months. Even with this type of rotation, a Saturday or a Sunday is free every weekend. During the second, third and fourth years of obstetrics and gynecology training, the call schedules may be every third (night) to as infrequent as every sixth night, with an average being about every fourth night. During the final or fourth year of obstetrics and gynecology residency, some assignments require an every third night but, here again, this does allow for at least one weekend day off per week.
It is important to recognize that during this first rigorous year, the house officer is closely supervised by senior residents and attending faculty physicians, protecting the patient from any errors of omission or commission related either to inexperience, lack of knowledge or other factors.
The medical profession is concerned about house officer working hours and is addressing these issues in its medical, scientific, and educational societies. The legislation of limited working hours is not the solution to this problem.
American medicine has not yet reached the point of the 9-to-5 doctor. The majority of our consumers wish to have continuing care from the same physician. Our residency education programs are teaching and demonstrating this type of practice. To legislate against it has broad implications to the entire structure of American medical practice.
CHARLES R. BRINKMAN III
MD, Professor and Chairman
Obstetrics and Gynecology
Harbor-UCLA Medical Center
