This Physicians News story can be republished for free. (See details)
It may look like fun on Grey’s Anatomy, but most real life surgical residents think about quitting.
About one-fifth of all surgeons will quit during the years of their training program. But what about the doctors who stick it out? What’s going through their heads? Most of them want to quit, too.
“The training of surgical residents is a long and arduous process that necessitates an immense investment of time for the trainee and the faculty,” said the authors of the study published in JAMA Surgery. “As such, resident attrition is a tremendous loss for all involved parties.”
Researchers surveyed 371 general surgery residents at 13 residency programs across the U.S. Of the 288 physicians who responded, 167 (58.0%) said that they had seriously considered leaving their surgical residency at some point during training. Why? Lack of sleep.
Sleep deprivation on a specific rotation was cited as the number one reason surgery residents want to leave the specialty. Also on the list: an undesirable future lifestyle and excessive work hours on a specific rotation.
“Although traditionalist old-school surgeons may still argue that making residency too soft will fail to prepare residents for the hard reality of surgical practice,” said Karen E. Deveney, MD, Oregon Health and Science University Department of Surgery. “This study offers a strong argument for programs to examine each of their rotations and take steps to improve the work hours of brutal rotations to create a more positive learning environment.”
The Accreditation Council for Graduate Medical Education (ACGME), the group responsible for overseeing all U.S. residency programs, in 2011 restricted the shifts of first-year surgical residents (interns) to 16 hours and limited the shifts of the more senior residents to 28 hours. The rules were changed, in part, due to a call for greater patient safety. But studies found the time restrictions may have caused more physician stress as they tried to do the same amount of work in the shorter, restricted time period.
The current survey shows that the time restrictions may need another tweaking. “With respect to sleep deprivation and work hours, this may suggest that it is the workload of an individual rotation that residents find most stressful rather than the rigor of the entirety of general surgery,” said the authors.
As for the argument that residents must endure long hours as part of an old-school hazing ritual to create the best, strongest doctors — well, that may not apply to Millennials and Generation Xers who “take control of their lives to a far greater extent than previous generations,” according to Dr. Deveney. “Young surgeons seek and find practices with structured hours and call,” she said. And “the starting salary of general surgeons is higher than ever.”
Dr. Deveney recommends that “program directors must take a purposeful, proactive approach from the beginning of surgery residency that shows residents how they can achieve a healthy balance of work and life, create practices over which they have control, and live happy, productive lives.”
(Photo by U.S. Navy via Flickr)