A study of the on-duty hours of surgical residents. Discussion

: A time study was done to ascertain the number of hours spent in the hospital and the types of duties performed by residents enrolled in a multiple-institution, university-sponsored surgical training program. On the average, residents in the Wright State University program spent 90.1 +/- 27.1 hours in the hospital per week. Direct patient care activities required 62.7 +/- 18.8 hours (69.6%) of the average workweek. Purely educational endeavors accounted for 10.0 +/- 6.1 hours (11.1%) of the workweek. Ancillary tasks consumed an average of 8.5 +/- 8.5 hours (9.4%) of the surgical residents' time on duty per week. House officers did obtain a mean of 9.1 +/- 11.0 hours of sleep in those working hours (10.1% of the total time spent in the hospital). Although much variation existed among hospitals in the program, on-duty hours were greater in the private hospitals compared to the federal hospitals; the principal difference was the amount of time spent doing ancillary tasks (10.0 +/- 9.4 hours vs 5.6 +/- 5.6 hours; p less than 0.01). Hours worked by residents on private surgical services were longer than those of residents assigned to staff services (96.4 +/- 22.1 hours vs 86.0 +/- 29.3 hours; p less than 0.04). Again, the major difference was the greater amount of ancillary tasks performed by residents on private services (12.0 +/- 9.5 hours vs 6.2 +/- 7.0 hours; p less than 0.001). This finding could not be attributed to differences in patient census or turnover rates. Longer hours were noted on the general/thoracic surgery services compared to other surgical subspecialties (94.1 +/- 27.3 hours vs 81.5 +/- 24.8 hours; p less than 0.02). More time was spent in direct patient care on general/thoracic surgery (66.3 +/- 19.3 hours vs 54.9 +/- 15.1 hours; p less than 0.002). Despite the shorter workweek, residents on subspecialty rotations spent more time doing ancillary tasks (11.3 +/- 9.7 hours vs 7.3 +/- 7.6 hours; p less than 0.02). More than 60% of the residents' working hours in this program exceeded the arbitrary 80-hour limit, emphasizing the challenge of complying with the imposition of maximum work hours. We recommend that each program closely monitor the activities and hours of its residents to best respond to the pressures for regulation.