No turning back: a blueprint for residency reform
Article Abstract:
Following the death of Libby Zion in New York, a patient whose death has been linked to the fatigue and stress of postgraduate (residency) medical training, the medical profession and state examiners have begun a re-examination of residencies in medicine and surgery. At this time, the medical profession has not developed an action plan that is definitive, and as a result the current status remains chaotic. In New York State, the Health Commission has developed a new set of work rules to govern residency work requirements. As of September 1, 1989, residents will be allowed to work only 24 continuous hours when serving on wards, and only 12 hours when serving in emergency units. Work schedules must now allow 8 hours between shifts and the aggregate work week must not exceed 80 hours. These changes in New York and the anticipation that similar regulatory changes will occur elsewhere are causing a re-examination of residency programs in general. Combined with state overview and examination of these training programs, the residents individually, and collectively through the formation of unions, are becoming more vocal about reducing their work load and improving their lifestyle. Concomitantly, continuing pressure on health care systems to reduce cost has compounded the dilemma, as the costs of decreasing work weeks have an immediate impact on institutional budgets. Stresses felt by residents include many which are shared with other young professionals, but some are relatively specific to residency. High on the list of residency-related stresses is sleep deprivation and loss of personal control over schedules and duty assignments. The threat of constant recall through the use of an electronic beeper, menial or "scut" work (moving patients, carrying examination data, etc.), and enormous information overload all add to the stressful feeling of residents. Often these stresses result in addictive behaviors, distress of personal relationships, psychopathologic personality changes, and professional dysfunction. Growing costs of providing malpractice insurance could mean multimillion dollar settlements, as pressure in the community for reduction of residents' work schedules increase. There is no going back, and the medical profession must offer relief, in spite of feelings within surgical and obstetrical professions that are resistant to change.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1989
User Contributions:
Comment about this article or add new information about this topic:
The ravelled sleeve of care: managing the stresses of residency training
Article Abstract:
Following the death of Libby Zion in New York City, whose death has been linked to the fatigue and stress brought on by postgraduate (residency) medical training, the medical profession and state examiners have begun to re-examine residency programs in medicine and surgery. At this time, the medical profession has not developed an action plan that is definitive, and consequently the current status remains chaotic. The New York State Health Commission has developed a new set of work rules to govern residency work requirements. As of September 1, 1989, residents will be allowed to work only 24 continuous hours when serving on wards and only 12 hours when serving in emergency units. Work schedules must now allow eight hours between shifts, and the aggregate work week must not exceed 80 hours. These changes in New York, as well as the anticipation that similar regulatory changes will occur elsewhere, are causing a re-examination of residency programs in general. Combined with state overview and inspection of these training programs, the residents individually, and collectively through the formation of unions, are becoming more vocal about reducing their work load and improving their life-style. Continuing pressure on health care systems to reduce costs has compounded the dilemma, as the costs of decreasing work weeks have an immediate impact on institutional budgets. Stresses felt by residents include many which are shared with other young professionals, but some are relatively specific to residency. High on the list of residency-related stresses is sleep deprivation and loss of personal control over schedules and duty assignments. The threat of constant recall through the use of an electronic beeper, menial or "scut" work (moving patients, carrying examination data, etc.), and enormous information overload all add to the stressful feeling of residents. Often these stresses result in addictive behaviors, distress of personal relationships, psychopathologic personality changes, and professional dysfunction.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1989
User Contributions:
Comment about this article or add new information about this topic:
Does quality influence choice of hospital?
Article Abstract:
Only in the last few years has information become available to the public about the quality of care in different hospitals. These statistics have been released by the media, peer review organizations, and the federal government, which publicized death rates of Medicare patients who had specific medical conditions. It is not known whether patients and physicians subsequently considered this information when making a choice about which hospital to use, or if quality of care was a factor in hospital choice even before objective data were available. Hospital records were examined to determine whether quality of care influenced the decisions of physicians and patients; the records examined were from California hospitals in 1983, before the hospital quality data were publicly released. The information collected from the medical records included diagnoses, procedures, outcomes, costs, and the ZIP code of the patient's residence. The results indicated that a hospital was more likely to be selected if it was affiliated with a medical school, and less likely to be used if it was a public hospital or farther away from the patient's home. The cases examined were those in which one of five medical diagnoses or one of seven surgical procedures was involved. For most of the surgical procedures and two out of five medical conditions studied, the hospitals with worse than average outcomes were chosen significantly less often. These findings suggest that quality of care was an important consideration in deciding which hospital to use even before specific data on quality of care were generally accessible. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: No turning back. Shape-shifting for women. H2O cardio
- Abstracts: Doctors fighting back, taking lawyers to court. Doctor apologizes for identifying jurors in malpractice case. MDs face unprecedented murder charge
- Abstracts: Taste of Medicare reform. GOP eases up on Medicare
- Abstracts: Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. Cocaine use and HIV infection in intravenous drug users in San Francisco
- Abstracts: A prospective study of human immunodeficiency virus type 1 infection and the development of AIDS in subjects with hemophilia