General surgery residents' views on work hours regulations

Abstract

Objective: Since 2003, compliance with Accreditation Council on Graduate Medical Education (ACGME) work hours regulations has been required for United States residency training programs. Further work hours restrictions have been proposed by the Institute of Medicine (IOM). This study examines General Surgery residents' views of current work hours restrictions and proposed changes by the IOM.

Design: An anonymous multiple-choice survey regarding work hours regulations was distributed to all US General Surgery residency program directors in 2009. Responses were compiled via an on-line survey program. Statistical analysis was performed in aggregate and by junior and senior resident responses.

Results: Nine hundred sixty-five (13.1%) general surgery residents responded. Responses demonstrated that 25% of surgery residents underreported work hours, with statistically significant differences between junior (22%) and senior residents (27%), p = 0.03. Sixteen percent of residents indicated they were instructed to report their work hours inaccurately, while 8% of residents advised junior or coresidents to report their work hours inaccurately. Sixty-five percent felt that other residents underreport their work hours. Junior residents (34%) were more in favor of increased work hours regulations than senior residents (17%; p < 0.001). The majority (52%) have underreported work hours to take care of a sick patient or perform surgery. Seventy-six percent are aware of the recent IOM recommendations for further work hours restrictions, of whom the majority felt that the IOM recommendations would make surgical training worse.

Conclusions: General surgery resident physicians in the US do not always record their work hours accurately and many have concerns about further work hour restrictions. The majority admitted underreporting work hours to care for a sick patient. Most US surgical residents feel further work hour restrictions would be detrimental to their training. Current work hours restrictions force surgery residents to underreport their work hours to perform the activities that they feel are necessary for their surgical training.