The 88-hour family: effects of the 80-hour work week on marriage and childbirth in a surgical residency

Abstract

The restriction of the resident physician work week to 80 hours has had dramatic affects on resident education and life-style. While effects on mood, psychological distress, and burn-out have been studied, the resultant changes in tangible quality of life have received little attention. Birth rate was considered a measurable, relevant outcome. The resident marital and parental status by duty month was collected from a single orthopaedic surgical residency program for the four academic years preceding and following the implementation of the 80-hour work week. The number of births to residents during these periods were also tallied. The relative prevalence of positive marital status changed very little between residents in the two time durations from 66 to 71 percent, but parental status increased from 27 to 43 percent. The number of births per married resident duty year also increased from 0.23 pre-restrictions to 0.32 post-restrictions. While the individual decisions involved in generating these observed changes are complex and difficult to entirely decipher, it is thought that an increased perception of life-control within the work-hour restrictions may have prompted the dramatic changes in birth rate among resident families.

Figure 1

The number of births to orthopaedic surgical resident families during the four years preceding and following the implementation of the 80-hour work week.

Figure 2

The distribution of the post-graduate-years status of the resident parents of the children born was fairly even between the pre- and post-restriction years. This argues against a more dramatic effect of the 80-hour work week on the earlier years of residency, with regard to birth rate.

Figure 3

These pie charts demonstrate the relative prevalence (in duty months) of single residents (white wedges), married residents without children (gray wedges), and married residents with children (black wedges) both before (A) and after (B) the implementation of ACGME work-hours restrictions.

Figure 4

This photo from an “Oortho Playgroup” outing to the fire station demonstrates the persistent absence of resident physicians in some of the most important departmental educational activities, even after implementation of the 80-hour work week.