It’s true, and is published in a recent NEJM article.
Residents in Europe work about 56 hours per week, and after August 2008, they will be allowed to work only 48 hours.
Sleep medicine experts state that current training restrictions with maximum 30-hour shifts and 80-hour workweeks are unsafe for both patients and physicians. A fine balance is being looked at as to where the optimal line of patient care vs. physician work hours can be drawn.
If you compare what US residents work to residents in Europe, the poor US guys and gals are working almost twice as much.
I think further work hour reform is on the horizon, especially if favorable data comes out of the decreased work hours for European residents. Only time will tell but I think it’s a push in the right direction. 80 hours per week is still too damn much.
Via: [NEJM]
There is a problem with these sleep regulations though coming into action in the UK. A typical consultant will have possibly 36,000 hours of training. With the new sleep directive, training time is cut to 8,000 hours. This could put patient care at a serious risk and arguable the long nights and several day shifts could be beneficial to patient care in the long run. Surely we don’t want a load of future consultants/residents who are only equivalent to junior docs with only a few years of experience now.
Wait, I cannot fathom it being so srtaighftowrard.
One thing you forgot to mention is that residency lasts much longer in Europe than in the United States.
Good point Half. Maybe it’s just me, but I think I’d almost rather have normal working conditions with a slightly more extended residency. Sure you’re missing out on some earning potential with the longer training session, but at least you have some semblance of a normal life during training.
Sorry, I totally agree with the normal working conditions I just thought it was an important issue to raise. I would prefer to see the training extended then to work all day and night.
i totally agree with issues re: sleep deprivation. it seems silly to me, though, to limit the hours that a person CAN be in the hospital working – if the person WANTS to be there, working. i know this is specific to me, but one of the reasons i am choosing the field i will be choosing is becuase it works my ass off – and that’s what i was looking for when i came to med school. i’d hate to be kicked out of hospital @ any set # of hours: i’ll go home when i WANT to.
then again, that’s just me.
mj, The problem with something like “we can only make you work 50 hrs but you can work up to 80 if you want” is that everyone would be coerced into working the 80 hours.
It’s like in college football in the summer they have “voluntary workouts” but you know very well that anyone not showing up to those won’t be starting in the fall.
these regulations are in effect all over europe. no one in europe works as hard as many in the US. medicine has been holding off the final restrictions for several years. one of the problems they are seeing in the UK now is that there are now more trainees and not enough positions to support them.
i spoke with one of the oxford academic physicians and he said it has been difficult to adjust to, but they have adjusted. they have seen their surgical numbers decrease and he did feel from their studies training (as far as surgical skill) is suffering somewhat. the question he raised was does it put patients in a dangerous position if their physicians have not had the volume of training. that is yet to be seen. they are also not as affected by malpractice as we are.
Another thought: Something is wrong with the current state of residency training if residents cannot fulfill training requirements working reasonable hours given the current training program lengths. For example, if surgical residents have a problem fulfilling the required number of procedures or cases within a 5-year period working 50 hours per week — that is the first thing that needs to be addressed.
Extending the surgical training length is really the only option to keep work hours in a safe and reasonable zone. The die-hard surgery residents that wouldn’t have it any other way will continue to train in surgery, but surgery training programs will probably see a decrease in interest across the board for surgical residencies if the number of years for training is increased.
hoover,
the hour change is only part of the problem and i think residencies will adjust. i do foresee further decreases in hours in the future. the problem is not necessarily the number of hours, it is the number of actual procedure time. in the surgical subspecialties, there have been so many advances, that the total number of procedures have increased. surgery is not just an operative field, it is important to have some clinical acumen as well as technical skill. the questions for general programs are what are the general skills you need to be competent surgeon, how many cases should you do to be able to be credentialed to perform that procedure, etc. the numbers of skill set that many in the surgical fields have to learn are just increasing. this is probably why we see so many going into specialties (limits the number of thing you have to be good at).
in orthopaedics, you are expected to be a generalist which requires skill sets in arthroscopy (shoulder and knee), total joint arthroplasty (hip and knee), basic spine (discs and single level fusions), sports (ACLs and non op management), fracture work, hand (excluding replants), basic pediatrics, tumor, shoulder and elbow, and foot and ankle. if you look in the CPT coding there are probably 200-300 different procedures. which are important? how many do you have to do? which re the key procedures? how do you learn to proper patient selection? most of these things in my field can be learned between 7am-6pm M-F.
the outcry i hear in general surgery is about early subspecialization. maybe that is the answer. only time will tell.
ps thanks for the visit.
Half, I’m not sure that European residency really lasts that much longer than in the USA. Remember for one thing– in Europe they start “medical school” (or the equivalent) right out of high school, while we have 4 years of undergrad in the USA. The Europeans tend to do basic/clinical science related coursework for 2 years, then ease into the more hands-on approaches.
And even if you discount this factor, I have doubts that the European hours adjustment would necessarily do that much to extend the residency. Think about it, in these crazy 80-hour (or more like 90 hour, in reality) work weeks we have in the USA, how much of that is actual training? And how much is utterly useless scut (though not all scut is bad)?
I’d say that maybe 20-25% of residency in the USA is actual training, the rest is gopher-work for the hospital for low pay that contributes little to training. That is– the European training-to-scut ratio is much better than in the USA.
So somebody training in, say, Milan or Barcelona or Berlin can have their cake and eat it too– more of an actual life while in residency, and still finish in a decent number of years since they’re not being scutted out, but actually training.
This has been basically borne out from what I’ve seen– I’ve met a good number of Europeans who’ve finished their fellowships, boarded in IM specialties like GI and Cardio, and they’re almost always younger, often a good deal, than the same people finishing fellowships in the USA. In fact, if you speak a language like Italian or French or German or whatever, maybe you’ve got it made– Europe seems to like US-trained docs and I’ve heard of people migrating over to the Eurozone.
Again, the issue here boils down to one word: Economics. As long as medical residents are seen as a cheap-worker gravy train for the hospitals, the current system won’t change.
Great comment, Striatus. Nicely done.
I’d like to point out for the record that Ireland is non compliant with the working time directive. We work worse hours than American doctors-weekends can be up to 56 hours straight with NO sleep. Several juniors I knew of DIED after these shifts, in car accidents and a couple from cardiovascular problems.