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Invited Commentary
September 2013

There Are Just Not Enough Hours in the Day

Author Affiliations
  • 1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
JAMA Surg. 2013;148(9):833. doi:10.1001/jamasurg.2013.2713

As stated in the article by Schwartz et al,1 surgical resident duty hours have been monitored closely since 2003—that was the year I arrived at Johns Hopkins Hospital and some actually thought the 80-hour work-week limitation was something I personally devised! The further restrictions have been the product of sleep deprivation studies and worry about both patient and surgeon safety. This article points out a predictable consequence of the hour restriction of lower numbers of cases recorded by surgical interns when comparing the 4 years before the new 16-hour work limit and the inaugural year of the new restriction. That change required programs to make substantial changes in their call schedules. We here at Hopkins now have interns working either a daytime shift of 5 am to 5 pm or 5 pm to 5 am, with every Saturday off. Handoffs are essential and must be done with expertise.2 We are trying to maximize the hours the intern is in the hospital while cases are going on; since we are 90% elective cases, 5 days a week works—at least for the day intern. The night intern is another story.

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