In order to secure an accreditation in jeopardy Monday, Yale-New Haven Hospital mollified officials by reducing the workload for its general surgery residents. Now, with few exceptions, residents will work a maximum of 80 hours a week and no more than 24 hours consecutively.
As part of a national trend toward squeezing more hours out of lower-paid workers, many of Yale’s surgical residents worked upwards of 100 hours a week or were on call every other night. The possibility of censure, while presumably petrifying to medical school administrators, was critical in provoking change.
And now Yale is the country’s reluctant model for forward-thinking medical residency programs.
Because Yale’s is a prominent program, the Accreditation Council for Graduate Medical Education’s threats here have caused hospitals around the country to re-evaluate the demands they place on already overworked residents. Meanwhile, Congress is considering limiting the number of hours residents are legally allowed to log per week.
Had the University’s residency program not been reaccredited, Yale-New Haven and the two other area hospitals where the 50 residents work would have lost their related federal funding. The current residents, of course, who need to complete an accredited program in order to get their licenses to practice medicine, would have fled to other programs. Failure to comply likely would have meant losing the program, an inconceivable risk.
Granted, officials at the medical school did not shorten hours for residents as an expression of good will and general concern for their well-being. They made the changes because the Accreditation Academy singled out Yale-New Haven Hospital as the first stop on a valid crusade to reform residency programs.
The reasons for Yale being first on the list are anyone’s guess, but it is difficult to imagine that the University’s program was considerably more egregious than any other in its treatment of residents. Certainly it is not just Yale-New Haven that has taken advantage of cheaper labor to avoid paying to employ more professionals. The 20 hours a week per resident lost to the amended policy probably will cost the hospitals more money. But in exchange, the program sets a valuable precedent.
Surgical residents are students too, and while longer hours provide more opportunities to learn, they also mean desperately tired surgeons-to-be are plodding through hospitals and dealing with patients.
Though the Accreditation Council’s rationale for choosing to impose the standard on Yale is perhaps suspect, the value of their goals in doing so is clear. By virtue of reputation, when Yale cuts back, others are likely to follow. And by virtue of accreditation, when Yale surgical residents work fewer hours, the program will be safer, more reasonable and more humane.