Physicians, Nurses Feel Differently About Capping Hours in OR

Marcia Frellick

October 31, 2018

A Medscape poll asking whether surgeons and others delivering care in the operating room (OR) should have caps on their hours found a large divide on the subject between physicians and nurses.

Answering the first question in the poll, which was first posted on July 18, about whether surgeons' hours should be capped to reduce harmful mistakes, 57% of physicians and 87% of nurses and advanced-practice nurses (APRNs) said yes. Ten percent of physicians and 9% of nurses were unsure.

A much larger percentage of nurses/APRNs than physicians also said that others' hours in the OR (such as those of nurses and anesthesiologists) should be capped (89% vs 62%).

The poll followed a Medscape story about an editorial by C. Niek van Dijk, MD, PhD, published in the Journal of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, which supported the caps for surgeons.

Van Dijk made the comparison with airline pilots and train drivers whose work hours are carefully monitored, and noted that these professions have drug and alcohol testing.

"Why aren't we surgeons monitored and similarly prevented from overworking?" van Dijk asks. "Are we assumed to be morally superior because of our Hippocratic Oath? Or is it because we can only damage the occasional patient if we are exhausted, rather than an entire planeload?"

An orthopedic surgeon who also commented on that story said the comparison with pilots is unfair.

The surgeon wrote: "Pilots really can be swapped out at any point — even midflight, because there is a co-pilot. 

"Who can afford to pay two surgeons to do a case that one can do alone? Who would be willing to?

"Patients don't want to think that their surgeon could possibly leave in the middle of their procedure. It's not part of the profession. We don't keep bankers' hours because we're not bankers."

How Do We Monitor Impairment?

Another surgeon who responded to the poll wrote: "There is little doubt that limiting work and monitoring for impairment will decrease errors. However, how much limitation and what exactly and how do we monitor impairment, a priori?"

Another question in the poll asked whether surgeons should be routinely monitored for negative behaviors, such as substance abuse, that could potentially affect their work. Again, a much higher percentage of nurses/APRNs than physicians answered yes (82% vs 62%).

Similar numbers answered yes when asked whether others in the OR (such as nurses and anesthesiologists) should be routinely monitored for negative behaviors (82% of nurses/APRNs said yes vs 64% of physicians).

Physicians' answers on whether surgeons' hours should be capped varied by specialty.

Table. Should Surgeons Have Their Work Hours Capped to Reduce Harmful Mistakes?

  Anesthesiologists % Internal Medicine % Orthopedic Surgery % General Surgery %
Yes 75 65 54 58
No 16 27 37 33
Unsure 9 8 9 9
Total 100 100 100 100

 

Anesthesiologists were also slightly more likely to say the hours for others should be capped as well.

 

Table. Should Other Professionals Who Work in the OR, Such as Nurses and Anesthesiologists, Have Their Work Hours Capped to Reduce Harmful Mistakes?

  Anesthesiologists % Internal Medicine % Orthopedic Surgery % General Surgery %
Yes 74 69 58 63
No 17 24 33 28
Unsure 9 6 9 9
Total 100 100 100 100

 

A general surgeon who responded to the poll said no to caps but yes to impairment monitoring.

"Impairment should always be monitored. Work hours: no," the surgeon wrote. "Only twice in my surgical life have I been pushed to my limit, and I recognized it both times. Once I had completed the surgeries, including emergencies, the other I transferred out. There is something about the OR that lights up the inner strength of the surgeon."

Some say the argument all comes down to money.

A plastic surgeon who commented on the poll writes: "In the end it doesn't matter what any of us think. [It] will be a debate between the third party payers who would love to see our surgery hours limited (creating a bottleneck to their outflow of cash) and the hospitals who make far more per case than any surgeon does."  

The poll received 623 responses from nurses/APRNs and 2439 from physicians for a total of 3062.

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