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How Many Hours Is Enough? An Old Profession Meets a New Generation
Sigmund Freud said that the two most important things in life are arbeit (work) and liebe (love)—in that order. Three essays in this issue (1-3) address fundamental themes about work: How hard should one work? What does it mean to be a professional? How can one find meaning in work and still lead a full life?
The catalyst for these essays is the 2002 ruling by the Accreditation Council for Graduate Medical Education (ACGME) that restricts residency work hours to less than 80 hours per week—on average—and less than 30 hours of continuous coverage at any one time (4). The authors view this change through different prisms. Charap (1), a seasoned, male faculty member, laments the new restrictions as harmful to continuity of care, housestaff bonding, and medical education. Furthermore, he asserts that the restrictions will have the most negative effect on weaker residents (1). By contrast, for Skeff and colleagues (2), the new restrictions enable long-needed innovations. In the spirit of creative destruction, tearing down the old system will allow residencies to re-examine educational programs and create new learning about teamwork, system improvement, and self-care of and by patients (2). Without the ACGME stimulus, these worthy goals would remain submerged under the inertial tide of business as usual. Finally, Glines (3), a female resident in family practice, reminds us of the sacrifices residents must make even when working in systems that meet the new requirements. Even a “slimmed-down” residency requiring less than 80 hours per week is engrossing and fatiguing and narrows one's life experience, as manifested in restricted …
