Reducing Resident Work Hours: Unproven Assumptions and Unforeseen Outcomes

“There must be some way out of here,” said the joker to the thief.

“There is too much confusion, I can't get no relief.

Businessmen, they drink my wine, plowmen dig my earth,

None of them along the line know what any of it is worth.”

“No reason to get excited,” the thief he kindly spoke,

“There are many here among us who feel that life is but a joke,

But you and I, we've been through that, and this is not our fate,

So let us not talk falsely now, the hour is getting late.”

–Bob Dylan

In the 25 years that I have been teaching in New York, graduate medical education has changed a great deal. Clearly, much has improved. However, the recent restrictions in work hours are an ominous development because of their effect on both patient care and the education of our future physicians (Table). Organizations that do not thoroughly understand the nature of graduate medical education are promulgating these restrictions. The forces cannot be dismissed; they include our governing bodies (1), state and federal government (2), and the public (3).

The restriction of work hours was codified in New York with the unfortunate death of a young woman, Libby Zion, the daughter of a well-known journalist. At the time of her death, work hours had already been reduced substantially. My mentors had described living in the hospital with only …