Continuity of Care: A Casualty of the 80-Hour Work Week

Fischer, Josef E. MD

Special Theme Article

The controversy concerning the limit of residents’ work time to 80 hours a week has generated unprecedented dismay for many involved in graduate medical education, particularly surgeons. The author maintains that 80 hours a week is too short a time for surgery residents to provide excellent care and that this new rule undercuts the importance of continuity of care, a principle highly valued by surgeons. General surgeons and those specialty surgeons most closely associated with them think of themselves as the last “compleat physicians,” who should and can take care of the entire patient, and that when difficulties arise, they should not transfer the patient to another physician but instead ask someone else to help them continue to care for the patient.

The author traces the arbitrary choice of an 80-hour work week (instead of a 92-hour one) to several sources, including the leadership of internal medicine, which he feels has largely de-emphasized patient contact for many years and has become focused on research and/or administration. He also maintains that the issue of moonlighting has also driven the push for an 80-hour work week, and that the view of moonlighting by surgical residencies (i.e., that it is almost always counterproductive) is different from that of other residencies.

He concludes by acknowledging that the 80-hour work week and the abandonment of the principle of continuity of care are societal decisions, and have occurred because surgeons and other physicians did not make their case strongly enough or in time.

Dr. Fischer is chairman, Department of Surgery, surgeon-in-chief, and Mallinckrodt Professor of Surgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts. He is a former chair of the American Board of Surgery, a current member of the Residency Review Committee for Surgery of the Accreditation Council for Graduate Medical Education, and a regent of the American College of Surgeons.

Correspondence and requests for reprints should be addressed to Dr. Fischer, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 3A, Boston, MA 02215.

For articles on related topics, see pp. 379–380, 384–385, 394–406, 407–416, and 447–452.

© 2004 Association of American Medical Colleges