Float or sink: a solution to the resident burn-out crisis?

Abstract

Introduction

As medical students, we were always told that medicine is a tough road. The training is gruelling with endless hours of studying, patient care, and considerable sacrifices in our personal lives. Many came into this profession ready for long hours and difficult training. However, until residency, it is tough to envision what the experience really entails. 

Recently, a debate erupted in the Medical Twitter universe when Dr. Colleen Farrell, an Internal Medicine resident at Bellevue Hospital in New York, wrote a tweet decrying 27-hour resident call shifts as inhumane. Dr. Farrell argued that residents and staff physicians deserve protection against harsh working hours and conditions on par with workers in unionized professions. For instance, the Ontario Nurses Association closely regulates how long nurses can work in a given day with the minimal time nurses must receive for breaks1. The ensuing debate saw numerous residents and staff physicians joining the conversation on either side of the argument. Many physicians argued that extended call shifts are a necessary part of resident training which equips residents to work effectively and independently in future demanding roles. On the other hand, many suggest that the lack of adequate rest and humane working hours leaves residents ill-prepared to make decisions and may hinder patient care. In the end, Dr. Farrell received heavy backlash that led to her taking a break from Twitter.

But what does the research say? Does reducing working hours improve resident wellness and patient safety? What is the impact on resident education? Can there be a way to balance resident wellness with competency and quality of care?