To investigate the reason for noncompliance with the work-hour regulation by surgical residents.
Nationwide anonymous survey (November 1, 2007, to March 1, 2008).
Surgical residents throughout the United States.
Main Outcome Measures
Incidence of noncompliance remains high and reasons for noncompliance are multifactorial.
The first 141 questionnaires returned were included in this analysis. Responders consisted of postgraduate year (PGY)–1 (32.6%), PGY-2 (19.1%), PGY-3 (17.7%), PGY-4 (13.5%), and PGY-5 (17.0%) surgical residents. Many residents were categorical (79.4%), male (61.7%), and married (53.2%). Ninety-eight percent of residents were aware of the work-hour regulation, with 72.1% of residents in favor of it. However, noncompliance with the work-hour regulation was 64.6%, with 21.1% of residents working more than 90 h/wk (average, 86.6 h/wk). The most problematic regulations to follow were “at least 10 hours of rest between duty hours” (36.9%), “24-hour limit of continuous care plus 6 additional hours for continuity of care and educational objectives” (26.1%), and “80-hour work limit over 4 weeks” (22.7%). Education and continuity in patient care were the main reasons associated with noncompliance. Noncompliance was highest in trauma (25.2%) and vascular surgery (16.3%) residents. In addition, 65.2% of the attending physicians do not agree with implementing work-hour regulation standards in the surgical faculty.
The survey demonstrates that noncompliance with the work-hour regulation is prevalent. The reasons for noncompliance are multifactorial. These findings will help restructure training programs in the efforts to increase compliance with the work-hour regulation.