The Journal of Bone and Joint Surgery (American). 2007;89:679-685.
doi:10.2106/JBJS.F.00526
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Measuring the Attitudes and Impact of the Eighty-Hour Workweek Rules on Orthopaedic Surgery Residents

Sharat K. Kusuma, MD, MBA1, Samir Mehta, MD2, Michael Sirkin, MD3, Adolph J. Yates, MD4, Theodore Miclau, MD5, Kimberly J. Templeton, MD6 and Gary E. Friedlaender, MD7

1 MBA Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104. E-mail address: sharat.kusuma{at}uphs.upenn.edu
2 Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359798, Seattle, WA 98101
3 University of Medicine and Dentistry-New Jersey Medical School, Medical Science Building, 185 South Orange Avenue, Room C-594, New Jersey Medical School, Newark, NJ 07101-1709
4 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Shadyside Medical Building, Suite 415, 5200 Centre Avenue, Pittsburgh, PA 15232
5 Department of Orthopaedic Surgery, University of California San Francisco, 1001 Potrero Avenue, Room 3A36, San Francisco, CA 94110
6 Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7387
7 Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, P.O. Box 208071, New Haven, CT 06520-8071

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the American Academy of Orthopaedic Surgeons. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Stryker, DePuy, Synthes, Zimmer, EBI, Stryker Biotech, and Smith-Nephew) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The literature on graduate medical education contains anecdotal reports of some effects of the new eighty-hour workweek on the attitudes and performance of residents. However, there are relatively few studies detailing the attitudes of large numbers of residents in a particular surgical specialty toward the new requirements.

Methods: Between July and November 2004, a survey created by the Academic Advocacy Committee of the American Academy of Orthopaedic Surgeons was distributed by mail, fax, and e-mail to a total of 4207 orthopaedic residents at the postgraduate year-1 through year-6 levels of training. The survey responses were tabulated electronically, and the results were recorded.

Results: The survey response rate was 13.2% (554 residents). Sixty-eight percent (337) of the 495 respondents whose postgraduate-year level was known were at the postgraduate year-4 level or higher. Attitudes concerning the duty rules were mixed. Twenty-three percent of the 554 respondents thought that eighty hours constituted an appropriate number of duty hours per week; 41% believed that eighty hours were too many, and 34% thought that eighty hours were not sufficient. Thirty-three percent of the respondents had worked greater than eighty hours during at least a single one-week period since the new rules were implemented; this occurred more commonly among the postgraduate year-3 and more junior residents. Orthopaedic trauma residents had the most difficulty adhering to the new duty-hour restrictions. Eighty-two percent of the respondents indicated that their residency programs have been forced to make changes to their call schedules or to hire ancillary staff to address the rules. The use of physician assistants, night-float systems, and so-called home-call assignments were the most common strategies used to achieve compliance.

Conclusion: Resident attitudes toward the work rules are mixed. The rules have forced residency programs to restructure. Junior residents have more favorable attitudes toward the new standards than do senior residents. Self-reporting of duty hours is the most common method of monitoring in orthopaedic training programs. Such systems allow ample opportunity for inaccuracies in the measurement of hours worked. Although residents report an improved quality of life as a result of these new rules, the attitude that the quality of training is diminished persists.


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