Yes. The key to training after medical school is hands-on experience -- the more, the better.
So much of practice is exposure to clinical situations. To make the most of training, one must be in the hospital as much as possible.
Few medical problems are solved quickly. They often demand follow-up, which means caring for patients over an extended period -- not heading off as soon as your eight-hour shift is over and coming back the next day to see what has transpired.
I don't think the 36-hour shift has to lead to depression. Anybody who can't adjust to it won't be able to perform well in general medicine or any demanding specialty.
Even in private practice, you get patients calling at all hours. They don't care if you're off call, or what you did that day. The demands of residency are probably not much greater than those of a very busy private practice.
I don't think being up all night necessarily detracts from a resident's ability to perform, if he has support from skillful colleagues with a team approach to medicine. I also don't think long hours impair his ability to absorb new information.
Committing yourself to a training program demands certain sacrifices. One is that your time isn't your own. You're dominated by the demands of your hospital.
You must choose whether being a good doctor comes first. If not, you'll resent the demands, which can wipe out your personal life.
But if your goal is to be the best doctor you can, then you will accept the demands -- though you sometimes resent them -- and build a personal life around your commitment. -- Dr. Peter W. Dillon senior resident in pediatric surgery Columbia-Presbyterian Medical Center, New York City
No. Educators are starting to realize that long shifts, which deprive residents of sleep and personal time, cause real impairment.
Testing we did here showed that stress is very high for the first year and a half. I think everyone suffers ill effects, though many don't recognize their own symptoms. A few must even be taken off duty and rehabilitated. With rest, most resume training.
Still, the unhealthy work hours make residency more a rite of passage than an educational experience. It's hard to stay sharp and make analytic decisions through long shifts. And this may lead to poor care and patient neglect, as is charged in New York.
Signs that residents are overstressed include changes in attitude or performance, extreme irritability with patients and faculty, depression and self-criticism.
Affected residents see themselves as antagonists to patients and feel everyone is making unreasonable demands. They may wonder whether going into medicine was a mistake.
But once training is done, doubts are covered up. Physicians accept the belief that if one can't survive long hospital shifts, one won't be able to handle the practice of medicine. Even third-year residents look at struggling interns and feel: We had to do it, so you have to do it, too.
We're trying to alter that here. We've built in a stress-management month in the first year of family-practice residency but haven't convinced other services to do so.
The time has come. If educators and hospitals don't ease training schedules, I think that legislation, as proposed in New York, will limit residents' work hours. -- Dr. Benjamin W. Goodman Jr. associate professor of family medicine and director of the Residency Program in Family Medicine Medical University of South Carolina, Charleston