Residents: Will They Ever Pay Off Medical School Debt?

Carol Peckham

Disclosures

August 05, 2014

In This Article

Resident Hours: A Challenging Issue

How Many Hours Do Residents Work?

On average, about half of all residents who responded to the Medscape survey spend 60 hours or more in the hospital each week, but the percentages trend significantly down over time, from 66% in the first year to 34% by the fifth. Over three quarters (76%) of male residents work over 51 hours per week in the hospital compared with 68% of women. This discrepancy might be one reason for the slight income disparity between male and female residents.[14]

Over three quarters of residents (77%) believe that the hours they work are sufficient for training, while 19% found them excessive and felt that they reduced the ability to focus.

More women than men are on call one to four nights per week (44% versus 37%), but fewer are on call five to 10 nights (37% versus 45%). In this survey, female residents also tend to work fewer hospital hours per week. Both factors may contribute to their slightly lower salaries.

The Debate Over Resident Hours

In 1984, Libby Zion, a college student at the time, died from cardiac arrest in a New York emergency room. Her father, Sidney Zion, a lawyer and writer for various New York newspapers, believed that her death was due to malpractice and particularly to the treating resident's exhaustion from work overload. He launched an extensive campaign to limit resident hours, and he succeeded. In 1989, New York State passed the Libby Zion Law, which limits resident hours to about 80 per week. After that, limits were adopted in other states. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted similar regulations for all accredited medical training institutions, and in 2011 it made further restrictions, including limiting first-year resident duty time from 24 to 16 consecutive hours.[15]

Whether these reduced hours improved patient safety is questionable, and some studies suggest that they don't.[16,17,18] A 2011 analysis from the ACGME found that mortality had improved since the 2003 requirements, or in any case had not worsened. However, there was a negative impact on education, particularly in surgery, which the authors found worrisome.[19] A physician writing in TheNew Yorker commented, "... residents spend less time directly caring for patients than they once did, and the feedback inherent in the hours once spent with more seasoned physicians has also diminished.[20] The 2011 rules may also pose a risk for increased cost.[21]

Some evidence suggests that female residents greet reduced duty hours more positively than male residents,[22] and women may respond to fatigue more negatively. In a study on post-call (being at work the day after having spent the entire previous day and night working), female residents felt less competent, less productive, and less energetic; male post-call residents felt more challenged and busier, although also more demoralized.[23]

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