In a recent Medscape edition (July 1,2008) we find a disturbing essay by a practicing academic pediatrician who expresses concern about some of the unexpected consequences of the restrictions placed on medical house staff work hours. I find it disturbing in part because what the author describes could not be further from the notion that the physician (house staff) should not leave until his patient is taken care of.
Dr. Jane R. Gilsdorf, from the University of Michigan Medical Center, pulls no punches with this sentence:
The current system is creating a legion of shift-worker physicians who leave when the clock strikes a certain hour rather than when the job has been completed.
In discussing this with a former partner, who taught internal medicine residents for over 30 years and retired one year after the work rule changes were implemented, he had this cynical comment to make:
"Maybe it is good that the residents learn that approach early on because it seems that most docs are becoming shift-workers. Consider how things often work. You have a primary care doctor who has defined office hours and when you call his number after hours you either get a "triage nurse" or a recording that basically says call back tomorrow if it is not an emergency or go to the ER if it is an emergency. At the ER you see an ER doc who is working a shift and if you are admitted you are likely seen by a hospitalist who also is a shift worker. The notion of a personal physician whose role transcends duty hours is dead in the water."
Dr. Gilsdorf opines that more funds are needed to help correct the problems brought about by the ACGME work restriction rules. Basically, someone needs to be paid to do much of what the house staff used to do and now cannot. Dr. R. Centor discusses some of the problems brought about by the ACGME work rules and suggests with good planning,teaching and hard work many of them can be at least to a significant degree mitigated and I believe he is probably right.
However,how the broader "shift-workerization" of physicians can be reversed is another matter.Major shifts in the economic forces regarding physician and hospital compensation have brought that about and that big ship will be hard to turn around.