What (If Anything) Is Wrong with Residency Overwork?
- Michael J. Green, MD, MS
- From the University of Wisconsin-Madison Medical School, Madison, Wisconsin. For the current author address, see end of text. Acknowledgments: The author thanks Robert Arnold, Alta Charo, Benjamin Horowitz, Norman Jensen, Mark Linzer, Judith Van Kirk, Daniel Wikler, and particularly, Norman Fost, for their thoughtful comments and critiques. Requests for Reprints: Michael J. Green, MD, MS, University of Wisconsin Medical School, Section of General Internal Medicine and Program in Medical Ethics, J5/210 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-2454. Current Author Address: Dr. Green: University of Wisconsin Medical School, Section of General Internal Medicine and Program in Medical Ethics, J5/210 Clinical Science Center, 600 Highland Avenue. Madison, WI 53792-2454.
Abstract
Long work hours during residency are a time-honored tradition. Efforts have recently been made to shorten work hours. This paper examines the main arguments supporting reform: that sleep deprivation is harmful to patients and residents and that it is exploitative. Because the data on the harms and benefits are mixed and because exploitation is difficult to prove, a stronger argument for reducing work hours is an ethical one: that overwork interferes with the development of professional values and attitudes that are an essential part of the moral curriculum of residency. Providing a climate that promotes moral growth during training is an important curricular objective that may be better achieved by shortening work hours, providing better resident supervision, and using substitute workers for some of the noneducational tasks of residency.
- Copyright ©2004 by the American College of Physicians
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