In the interest of full disclosure, I should admit at the outset that I don’t have any basis for comparing anything to fraternity hazing. I wasn’t in a fraternity, so any impression of what pledges go through to join is pieced together from mediocre movies and a few observations of others during college, plus a few hints from friends who were in one. Perhaps it’s a really lovely experience, full of heartfelt chats over soothing cups of chamomile tea. However, as far as I can tell, it’s a lousy, unpleasant ordeal, meant to instill some kind of loyalty to the institution inflicting the punishment for those who make it through.
I remembered a similarly unpleasant loyalty-building exercise of my own when listening to a report about new rules for residents at Maine Medical Center the other day. The change came in response to new guidelines from the Accreditation Council for Graduate Medical Education, which governs how residencies are run.
Shifts of 24 hours, with a further six hours tagged on for followup work, were not uncommon for first-year residents to endure–until now. New rules drawn up by the Accreditation Council for Graduate Medical Education have just come into effect nearly halving the maximum number of hours that medical residents in their first year can work in one shift.
Like previous years, they’ll still be working up to 80 hours a week, but no shift can be longer than 16 hours. The aim is to cut down on the number of medical errors made due to fatigue and sleep deprivation. Dr. Tom Gearan is the residency program director for internal medicine at Maine Med.
“What they’ve done is really look at changing the paradigm of residency education, where traditionally the first year of residency has been among the toughest year,” Gearan says. “So we have our least-experienced residents sometimes working the longest hours. And the ACGME really felt that the first-year residents really should be more structured and supervised when they come out of medical school, and then over the years of training that they gradually increase their hours.”
My residency was relatively benign, as far as sleep deprivation went. We had a night-float system, with one team covering the day shift and another covering nights for a week at a time. We had occasional long (24-hour+) shifts, but they were infrequent. Even so, I remember being so tired after long shifts or a particularly arduous week of nights that it felt like I was walking through pudding as I made my way home. I was well-aware that other residencies (whether for other specialties within my own hospital, or at other institutions) were much worse, and was grateful enough that mine didn’t inflict more suffering.
I’m not quite sure what I was meant to learn during those long, poorly-supervised stretches that couldn’t have been taught in a less draining manner. The real reason for the slog that is residency is two-fold. First of all, hospitals need to have physicians present at all times to deliver patient care, and residents are an inexpensive way to keeping the place staffed. This is a legitimate need, and meeting it does require longer hours than attending physicians are usually expected to put in. I’m much more iffy on the second reason, which is to instill an attitude summarized by the following exchange:
While he can see the sense in the new rules, Dr. Parker is nevertheless glad to have earned his spurs under old system. “Following in the footsteps of some of the older physicians who’ve actually done these long hours, you know I think there’s a certain pride in doing what these older physicians have done, even though the hours were very hard and challenging.”
Tom Porter: “Like a badge of honor?”
Ryan Parker: “Exactly.
In other words, hazing. Get the snot beaten out of yourself for a few years, and at the end you’re a real doctor.
To which my reply is an obscene gesture that doesn’t translate well into blog form. Suffice it to say that jeopardizing patient safety by giving bleary-eyed residents charge over complex medical decisions is a craptacular way of fostering some rarefied notion of true doctor-hood. You learn to be a doctor by being a doctor, not by achieving some feat of strength. You can’t “learn” how to function on too little rest, you can just endure it.
Every physician has to have a first day on the job. Whether those first days are particularly dangerous for patients is an open question, it seems. But first-year residents are going to be stressed enough by the demands of all that they will be expected to learn and do without expecting them to do it and learn it on insufficient sleep. “I had to make it through” is a poor rationale for continuing a dangerous practice for those that come after us.