David Baxter PhD
Late Founder
A Fatally Flawed Medical Educational Model
by John Grohol, e-patients.net
December 3, 2008
This week, many news outlets reported on how residents should be given 5 hours of sleep after working 16 hours.
Think about that for a moment.
In what other job ? any job in the world ? would it be acceptable to even use the term ?after working 16 hours.? The 16 hour workday went out with the Industrial era here in the U.S. (Residents can actually be required to be on-call for up to 30 hours at a time, which is even more absurd.)
What other job in the world would we entrust the world?s most precious, irreplaceable resource ? people ? to professionals who are fatigued, worked-to-death, and under incredible stress with no hint of any kind of normal social or family life?
And yet, that is exactly how today?s medical educational model is setup. Doctors, in order to become doctors, must go through a residency period where they are literally worked until they can work no longer. Old adherents to this model suggest (with absolutely no research support) that it helps train doctors to work under pressure that the job requires. They also explain to us that it?s the only way we can afford to educate and train doctors (since anything else would require normal working hours and more doctors for coverage).
But few doctors go into an E.R. setting after residency, where such critical, immediate thinking skills would be most used and invaluable. And as for the economics of the model, well, that?s the same excuse industrialists used to explain why they needed to employ children to work in their factories in the late 1800s. And why few workers were paid a living wage (outside of the company housing).
We banned such barbaric practices back then recognizing that for a society to function and thrive, it must protect taking advantage of its citizens by companies or organizations who don?t care about the individual.
Ostensibly, guidelines are in place to try and reduce the continuing abuse of residents. They are supposed to now work no more than 80 hours per week, but this is easily skirted by averaging time worked over an entire month (so you can work 110 hours one week, and a joyous 50 another). That?s because there?s no incentive for teaching hospitals and medical schools to start acting humanely toward their residents. Apparently it?s still okay to abuse people?s rights, as long as those people are doctors in training.
I find this medical training model appalling and inhumane, and always have. Contrast it with the model under which I was trained. In psychology, future psychologists spend a year on internship, which have normal working hours (40 per week). We learn just fine. We treat people who have no money in community mental health centers. And we do significant outreach with whatever local resources are available. We have a normal family life, with many of my colleagues starting their family on internship or fellowship (an optional training year or two after internship). We hone our clinical skills while on internship, and we do so in an environment that is actually conducive to learning.
Residents need to take a stand for humane working conditions. Working 30 hours straight is unheard of for nearly every other profession in this country (with a few rare exceptions). It is unacceptable in a civilized society, and a flawed model from its original design. A doctor can be just as well-trained working normal hours (40 to 50 per week), and likely learn a lot more if they were under less stress and pressure from their work environment.
by John Grohol, e-patients.net
December 3, 2008
This week, many news outlets reported on how residents should be given 5 hours of sleep after working 16 hours.
Think about that for a moment.
In what other job ? any job in the world ? would it be acceptable to even use the term ?after working 16 hours.? The 16 hour workday went out with the Industrial era here in the U.S. (Residents can actually be required to be on-call for up to 30 hours at a time, which is even more absurd.)
What other job in the world would we entrust the world?s most precious, irreplaceable resource ? people ? to professionals who are fatigued, worked-to-death, and under incredible stress with no hint of any kind of normal social or family life?
And yet, that is exactly how today?s medical educational model is setup. Doctors, in order to become doctors, must go through a residency period where they are literally worked until they can work no longer. Old adherents to this model suggest (with absolutely no research support) that it helps train doctors to work under pressure that the job requires. They also explain to us that it?s the only way we can afford to educate and train doctors (since anything else would require normal working hours and more doctors for coverage).
But few doctors go into an E.R. setting after residency, where such critical, immediate thinking skills would be most used and invaluable. And as for the economics of the model, well, that?s the same excuse industrialists used to explain why they needed to employ children to work in their factories in the late 1800s. And why few workers were paid a living wage (outside of the company housing).
We banned such barbaric practices back then recognizing that for a society to function and thrive, it must protect taking advantage of its citizens by companies or organizations who don?t care about the individual.
Ostensibly, guidelines are in place to try and reduce the continuing abuse of residents. They are supposed to now work no more than 80 hours per week, but this is easily skirted by averaging time worked over an entire month (so you can work 110 hours one week, and a joyous 50 another). That?s because there?s no incentive for teaching hospitals and medical schools to start acting humanely toward their residents. Apparently it?s still okay to abuse people?s rights, as long as those people are doctors in training.
I find this medical training model appalling and inhumane, and always have. Contrast it with the model under which I was trained. In psychology, future psychologists spend a year on internship, which have normal working hours (40 per week). We learn just fine. We treat people who have no money in community mental health centers. And we do significant outreach with whatever local resources are available. We have a normal family life, with many of my colleagues starting their family on internship or fellowship (an optional training year or two after internship). We hone our clinical skills while on internship, and we do so in an environment that is actually conducive to learning.
Residents need to take a stand for humane working conditions. Working 30 hours straight is unheard of for nearly every other profession in this country (with a few rare exceptions). It is unacceptable in a civilized society, and a flawed model from its original design. A doctor can be just as well-trained working normal hours (40 to 50 per week), and likely learn a lot more if they were under less stress and pressure from their work environment.
