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Why Resident Duty Hours Regulations Must Address Attending Physicians’ Workload

Wong, Brian M. MD; Imrie, Kevin MD

doi: 10.1097/ACM.0b013e31829e5727

For much of the past decade, the duty hours debate has focused primarily on the intended and unintended effects of resident duty hours restrictions on resident well-being and fatigue, patient safety, discontinuity and handoffs, and opportunities for teaching. On the other hand, attending physicians’ needs and perspectives generally have been ignored. The authors of this commentary discuss the report by Roshetsky and colleagues in this issue of Academic Medicine, which found that attending physicians reported a greater clinical workload since the implementation of the 2003 Accreditation Council for Graduate Medical Education resident duty hours regulations, and that this increase in attending physicians’ workload appears to correlate with decreased time for teaching. However, attending physicians not having time to teach may be but the tip of the iceberg. Other potential implications include faculty members’ decreased availability for direct supervision of residents, their reduced emphasis on resident assessment, and their burnout and dissatisfaction, which ultimately also negatively affect patient care. Therefore, deliberate efforts to address attending physicians’ workload must receive greater attention if the duty hours movement is to achieve its ultimate goal of improving patient outcomes. In this commentary, the authors advocate that duty hours regulations require programs to seek creative solutions to address these issues, just as the 2011 regulations require programs to address patient handoff training.

Dr. Wong is assistant professor and director, continuing education and quality improvement, Department of Medicine, University of Toronto; associate director, Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto; and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada.

Dr. Imrie is professor, Department of Medicine, University of Toronto; vice president of education, Royal College of Physicians and Surgeons of Canada; and physician-in-chief, Department of Medicine, and staff physician, Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada.

Funding/Support: None.

Other disclosures: None.

Ethical approval: Not applicable.

Correspondence should be addressed to Dr. Wong, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H466, Toronto, Ontario Canada M4N 3M5; telephone: (416) 480–4290; e-mail:

© 2013 by the Association of American Medical Colleges