On July 1, 2003, work-hour reforms were enacted nationally for the roughly 129, 000 resident physicians in the United States. The reforms limit weekly work hours (a maximum of eighty per week) and in-hospital call (no more than once every three nights), mandate days free of clinical and educational obligations (one day in seven), and regulate other aspects of resident work life.
Why Surgeons Struggle with Work-Hour Reforms focuses on general surgeons, a historically long-hour specialty, who fiercely opposed the reforms and are among the least compliant. Why do surgeons struggle with the reforms? Why do they continue to work long hours and view the act of doing so as reasonable if not quintessentially professional? Although the analysis is situated in the growing scientific literature on the consequences of fatigue, the authors do not adjudicate between the claims of surgeons and reform advocates about the effects of long work hours on patient or provider safety. Rather, the aim is to explore and explain how aspects of the occupational culture of surgeons and the social organization of surgical training and practice interlock to impede the reforms.
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Acknowledgments
Introduction. Explaining the Struggle: Culture, Social Organization, and Work-Hour Reforms
Chapter 1. Fatigue as Impairment or Practical and Educational Necessity?
Chapter 2. Patient Handoffs: Can’t Colleagues Assume Care Capably?
Chapter 3. Stay or Go Decisions by Residents: Why Not Leave When a Day Shift is Overor Hour Limits are Reached?
Chapter 4. Professionalism, Old and New: Time and Morality in Surgical Trainingand Practice
Chapter 5. Less for You, More for Me? Changing Workloads for Attendings and Advanced Practice Providers
Chapter 6. Revisions Imposed and Rescinded: The Sixteen Hour Shift Limit for Interns
Conclusion. Policy to Practice: Muddling Through Work-Hour Reforms
References
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John D. Mellinger is professor and chair, Division of General Surgery, and vice chair, Department of Surgery, at Southern Illinois University.
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