(from the April 2017 ACP Hospitalist)
Residency programs, hospitalists strive to strike right balance
Hospital as permanent habitat may have been the norm for the first residents, but today's trainees and hospitalists are battling for balance. For them, scheduling means far more than personal druthers; it's a matter of safety and quality鈥攚ith patient care, physician well-being, and resident learning on the line.
Over the past 30 years, hospital life has changed dramatically, from the advent and adjustments of resident work hours to the birth and boom of hospital medicine. Before restricted work hours, trainees worked under less supervision, with no ancillary services and less advanced medical treatments, caring for many patients who could now be treated outside the hospital, said Mark A. Levine, MD, FACP, associate dean for graduate medical education and professor of medicine at the University of Vermont College of Medicine in Burlington.
鈥淚n my day, we were also the IV technicians, we were also the phlebotomists, we were involved in patient transport, and those are tasks that we would never push on a resident at this point in time,鈥 said Dr. Levine, who is an ACP Regent and Chair of ACP's Education and Publication Committee. 鈥淣owadays, we really believe that if residents are going to spend all these hours in the hospital, they better be learning all that time, and they better be doing tasks that are appropriate for the education they've received.鈥
Hospitalists have also seen their schedules shift, and the initial default of seven on/seven off appears to be falling somewhat out of favor, with flexible schedules increasing in popularity. All the while, residents' schedules are incongruous with those of practicing hospitalists, said Thomas G. Cooney, MD, MACP, a professor of medicine and vice chair for education of the department of medicine at Oregon Health & Science University in Portland and Chair of ACP's Board of Governors.
Most recently, in March, the Accreditation Council for Graduate Medical Education (ACGME) finalized work-hour rules for the 2017-2018 academic year that lift the 16-hour work limit for interns and allow all residents to work up to 28 continuous hours, among other provisions.
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