Tellingly, it also noted that the degree to which the prevalence is underestimated increases as one moves up the hierarchy. It concluded that members of the medical hierarchy are likely to minimize the prevalence of serious distress among residents. Could a surgical culture wedded to intensive training be affecting the results of its own performance studies?Īt least one report, published in 1989, has examined possible bias in the medical community. Although this might be a coincidence, it merits closer examination.
This suggests a possible connection, in which the specialty reporting the highest level of resident abuse also tends to minimize the impact of sleep deprivation. In a national survey, surgical residents reported the most hours on call, while surgical and obstetric residents reported the highest levels of sexual harassment, discrimination and other types of mistreatment during their training. According to the Journal of the American Medical Assn., surgery training programs consistently demand more time and effort from their residents than virtually any other specialty. The reasons for this discrepancy are unclear, but surgical programs stand out in other respects as well. In one study conducted by surgeons at the Medical College of Wisconsin, for example, sleep loss had no apparent effect on cognitive performance.
This may explain a curious anomaly seen in a number of surgical investigations: According to the Journal of Occupational and Environmental Medicine, studies of surgical residents frequently show that sleep deprivation has little impact on performance, in contrast to studies conducted by other medical specialties. It also found that the effects of sleep deprivation may actually be underestimated.
A 1996 review in the journal Sleep that examined 19 research projects found that sleep deprivation strongly impairs human function. Though further research is needed to clarify the matter, other studies have shown a similar pattern. Medical residents certainly fit these criteria. Journal reported that this could have significant implications for individuals whose work requires continual learning as well as high standards of performance. In a 1996 report, researchers concluded that learning and memory can be impaired by sleep loss that occurs several days after new tasks have been learned. In fact, multiple studies have shown that learning may be adversely affected by the severe sleep deprivation endured by thousands of doctors-in-training. Cohen argues that the educational aspects of physician training should take precedence over other issues, and that unionization or collective bargaining threaten the ideals of a medical education.īut a growing body of evidence suggests that the education of residents is suffering because of the extraordinary stress of medical training. But for critics of the system, it is hard to see how that trust is enhanced by forcing young doctors to work interminable hours-up to 36 hours at a stretch. Cohen, the AAMC president, called such binding arbitration an “abhorrent idea” that would violate the trust that must exist between student and teacher. of American Medical Colleges, which opposed the NLRB decision, worries that the threat of strikes or binding arbitration will undermine the educational mission of hospitals. Of course, some in the profession might object to being classified as mere mortals. In seven days, they are expected to cram in as much as 100 hours of work, and a single shift can last as long as the average mortal’s entire workweek. This could represent a substantial threat to the nation’s 400 teaching hospitals, since it gives young doctors a potent new weapon in the fight to improve their dismal working conditions.Īs the junior members of the medical hierarchy, residents typically work longer hours than any other professionals on the planet. The new ruling reverses this decision and paves the way for the widespread unionization of both interns and residents. The original ruling, handed down in 1976, officially classified medical residents as students rather than as employees, thereby preventing them from organizing themselves to obtain better working conditions. In a dramatic turnaround, the National Labor Relations Board recently overturned an earlier ruling that prevented American doctors-in-training from joining labor unions. Now, the profession has yet another interloper encroaching on its terrain. At the outset of the 21st century, the nation’s medical establishment is under siege, pummeled from all directions by cost-conscious bureaucrats, dissatisfied patients and the colossus known as managed care.