Joel Schofer, MD, Emergency Medicine, 01:06PM Sep 8, 2010
Recent posts about career selection and resident burnout have led to discussions about residency work hours. On one hand, things are a lot better than they used to be. I trained both with and without residency work hour restrictions. I remember the days when I was on trauma surgery, my son was born, and they wouldn't let me leave to drive my wife home from the hospital. They said I had used up all of my days off when my son was born and didn't have any left. A few years later on trauma surgery they were practically shoving us out the door so that we wouldn't even come close to committing a work hour violation!
Medical students often assume that all residencies are compliant with the work hour restrictions. If a residency program is not compliant, they risk losing their accreditation, so you would think there is an incentive to comply. But all is not perfect in the world, and in a lot of residencies work hour violations are rampant. They just don't get reported!
I'm not sure why residents don't report the work hour violations. Reporting is anonymous, so there should be no personal consequences. In most instances it is probably a fear that reporting a work hour violation could lead to problems with the residency program, such as a loss of accreditation or a probationary period, and no one wants to graduate from a program that is on probation or relocate because their program is no longer accredited.
So how do prospective residents find out the real deal? How do you know if a residency program is compliant with resident work hours?
First, ask the residents during your interview/visit. If the program is one of those places where residents just quietly accept the work hour violations, you may not get an honest answer. If you don't ask, though, you're guaranteed to get no answer at all, so I would always ask.
Second, if you meet any rotators during your visit, such as transitional interns or off-service residents, you can always ask them about work hours. They will have less "loyalty" to the program (since it isn't their program), and are more likely to answer your questions about work hours honestly. And don't forget about any medical students you might meet as well. They are even more likely to give you their opinion about the life of the residents they interact with every day.
It would be great if you could assume all residency programs are compliant with work hour limits, but they are not and you shouldn't assume compliance. Make sure you ask the residents, off-service rotators, and medical students on the interview trail.
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