I don’t know why I didn’t think of it sooner, or like many great ideas, why someone else didn’t come up with it already. As I lay awake one morning at 4:30, having just received a consult from internal medicine for an elderly lady being admitted with gallstones, atrial fibrillation and acute dehydration, (which could have waited until 7:00 a.m. today or even tomorrow) it hit me. I had the solution to the resident work hour controversy. Many years ago, I was in the Navy and served on a ship. Crew members “stood watch,” which consisted of four-hour rotations on duty followed by eight hours off duty. Thus, each crewmember worked eight hours per day, but the work time was divided into two four-hour shifts. To me, this seemed to be the perfect solution to the resident work hour dilemma. I know, you are saying, “but Skeptical Scalpel, wouldn’t that mean six patient hand-offs per day?” Yes, of course it would. But according to the proponents of reduced work hours for residents, hand-offs are not a problem for continuity of care or patient safety. It’s better to have discontinuity instead of tired residents. So if two or three hand-offs per day are OK, why not six? Still, there are a few issues that need to be worked out. For example, surgical residency training would have to be increased to 8 or 9 years duration. Operations would have to be scheduled carefully to enable a resident to participate from start to finish, and all operations would have to last fewer than four hours. Also, each residency position currently filled by a single individual would require three people. Who is going to pay for that? Well, no one was concerned about who pays for the regulations limiting first-year trainees to 16-hour days. There are also weekends, vacations, and holidays, which would require extra residents to cover. Hospitals would need to provide quarters for trainees. It would be like the good old days when residents lived in the hospital. It’s possible that I overlooked something, so in conforming with the methods of regulatory agencies like the Accreditation Council for Graduate Medical Education, I will give you 45 days to comment, after which I will implement these new and improved work hours as stated. Source
