A national survey of residents' self-reported work hours: thinking beyond specialty

Abstract

Purpose: To secure data from residents regarding residency work hours and correlates.

Method: A national, random sample of postgraduate year 1 (PGY1) and year 2 (PGY2) residents in the 1998-1999 training year was identified using the American Medical Association's Graduate Medical Education database. Residents completed a five-page survey with 44 questions and 144 separate data elements relating to their residency experience.

Results: Completed surveys were received from 3,604 of 5,616 (64.2%) residents contacted. PGY1 residents reported working an average of 83 hours a week versus 76.2 hours for PGY2 residents (p <.0001). Total work hours were significantly correlated with reported stress and hours of sleep per week. Residents averaging more than 80 work hours per week were more likely to be involved in a personal accident or injury, a serious conflict with other staff members, and making a significant medical error. Cluster analysis revealed four different types of residency experience: high intensity, moderate intensity, low intensity, and moonlighters, suggesting that residents may have some choice in selecting a residency experience suited to their particular personal and professional needs.

Conclusion: Nearly half of PGY1 and one third of PGY2 residents reported working more than 80 hours per week. These extended hours are significantly correlated with a number of patient care and personal health variables. Given the variety of program and specialty requirements and demands, it seems unlikely that an arbitrary limit or a simple decrease in work hours will provide a satisfactory solution to many resident and patient care concerns.