Residents' perceptions of the effects of work hour limitations at a large teaching hospital

PURPOSE: To assess residents' perceptions of the impact of resident work hour restrictions on patient care, education, and job satisfaction. METHOD: Four focus groups of internal medicine residents at Barnes-Jewish Hospital at the Washington University School of Medicine were conducted during February and March 2004. Twenty-six housestaff from the first three years of residency participated; all were volunteers. Transcripts were analyzed for major themes. RESULTS: Both residents and interns supported work hour limitations and enjoyed the benefits of working fewer hours. However, they had difficulty complying with the restrictions, particularly if they felt patient care, teaching, or their own education would be compromised. Participants perceived that restricted work hours diminished the continuity of patient care and increased the likelihood of medical errors such as those resulting from delayed follow-up of diagnostic tests. Both interns and residents found it difficult to attend conferences, and residents found fewer opportunities to teach. Effects on job satisfaction were mixed as a result of work hour restrictions. CONCLUSIONS: Residents in the sample favored work hour restrictions but had serious concerns about the effects of the restrictions on patient care and medical education. The findings suggest that imposing rigid work hour restrictions has significant consequences for patient care and medical education and that the most effective ways to balance work hour limitations with the demands of patient care and necessary educational components to train competent physicians have yet to be identified.