Residents at neurosurgery training programs oppose new regulations limiting duty hours

Residents at U.S. neurosurgery training programs strongly oppose new regulations that further limit their duty hours, according to a survey study in the December issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. The study was performed by Dr. Kyle M. Fargen and colleagues at the Department of Neurosurgery at the University of Florida in Gainesville.

Eighty-Hour Work Week Isn't Enough, Neurosurgery Trainees Say
The researchers sent a survey to residents enrolled in 101 neurosurgery training programs in the United States and Puerto Rico. The residents were asked for their views on the new rules, which limit the maximum shift lengths of doctors in training, as well as the perceived effects of the limited hours on their education. These surveys were distributed prior to the new rules taking effect in July 2011. Responses were received from 377 residents, representing about one-third of all U.S. neurosurgery residents.

More than one-third (36 percent) of the residents said they had violated the 80-hour limit at least occasionally. A significant minority of respondents said they had been involved in a traffic accident (eight percent) or made a medical error resulting in patient harm (six percent) after working an extended shift. Yet the residents disagreed with a statement that reduced work hours would help to limit fatigue—a statement that appears to be "objectively and logically true," the researchers note.

More than 80 percent of respondents disagreed with regulations limiting first-year residents to 16-hour work shifts. Most believed that hospitals would need to hire additional residents or health aides to perform necessary patient care duties.

Most of the neurosurgery residents believed they should not be subject to the same duty hour regulations as residents in other specialties. Most agreed that the restrictions would decrease their surgical and educational experiences.

The percentages only began to capture the vigor of the residents' opposition. Some respondents provided extensive comments expressing "an overwhelmingly negative attitude towards not only the duty hour regulations but to the governing bodies overseeing the institution of such regulations," Dr. Fargen and colleagues write.

The findings highlight the "considerable criticism and concern" over the new work hour restrictions. "Most residents report the new regulations will worsen duty hour violations, fail to reduce medical errors or fatigue, reduce operative exposure and educational experiences, and overall have a negative effect on their residency training," the researchers write. They note that none of the survey questions received a predominantly positive response.

Dr. Fargen and coauthors raise the question of why the residents are so strongly opposed to the new rules—despite evidence of medical errors and traffic accidents related to long work hours. They write, "An inescapable conclusion seems to be that neurosurgery residents are more concerned about their education and/or their autonomy to act as they choose, as opposed to patient safety and their own health."