The institute of Medicine, Department of Health and Human services and others have brilliantly come to the aid of your future doctors. Residents all over the country are looking forward to a reprieve from the oppressive schedules that have characterized post-graduate training in the United States for decades. The new "proposals" will limit their shifts to 16 hours with a mandatory 5 hours of uninterrupted sleep before any return to duty. In a week the total hours on-duty will be limited to 50. Of course that means that there are 8 hours that are left for someone else to work each day and a total of 118 hours per week.
The obvious question is who will care for the patients those other hours? In the past some surgery residencies split the 168 hours "evenly" at 100 hours for each resident. The complaint was the famous, "I miss half of the good cases" - when sharing with another.
Now that same work requires 4 surgery residents to cover the hours.
The problem: There are no extra doctors coming through the system to fill the required slots. So, where might a qualified provider be found? What hours will these new residents work once they finish their training? Most practicing physicians learned the ability to work long and hard during those training years. Where will the new doctors, the ones that are far fewer in number than the population will require, learn to work at 03:00?
One answer is the teaching staff of the institutions wherein the residents learn. Of course those older, less resilient doctors are even less capable of functioning deep in the dark hours of a night. And teaching after being up all night? Intellectual functioning for teaching is an early victim of sleep deprivation. So, the now fresher, "safer" residents get less oversight and instruction.
Perhaps physician extenders, or independent nurse practitioners can fill the bill. I think that the 6 years of post-high school diploma training required to become a nurse practitioner may lack some of the finer points of medical training that are part of the 13 years post high school training a surgeon must endure.
So, as we all age, it is interesting to think who might be at our bedsides at 03:00 in an emergency. Will we be alone, holding our breath until the doctor finishes the 5 hour nap?
Wednesday, December 10, 2008
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