Doctors fresh out of medical school are working fewer hours compared to their predecessors, thanks to new rules curbing duty time that went into effect a year ago.
But growing pains abound. Some medical students and experienced doctors are getting stuck with more work, and hospitals are spending millions of dollars overhauling work schedules.
The new demands were put in place last July after persistent concerns that excessive hours clocked by wearied residents may put patients at risk.
"All of these changes have been done with an eye toward improving the quality of patient care," said Jordan Cohen, M.D., president of the American Association of Medical Colleges, representing more than 400 major teaching hospitals.
The guidelines, adopted by the Accreditation Council for Graduate Medical Education, which oversees more than 7,800 residency programs, limited duty hours to 80 hours a week for the nation's nearly 100,000 doctors-in-training.
Before that, it was not uncommon for residents in certain specialties, such as surgery, to log more than 100 hours a week. Today's residents also must get at least 10 hours of rest between shifts and cannot be on duty for more than 24 hours straight.
Jeff Huebner, M.D., a third-year family medicine resident at the University of Washington in Seattle, has borne his share of working excessive hours but now has more energy to teach interns and treat patients.
"There's a culture shift," said Huebner, 29. "Many residents in our generation of doctors view that you don't have to work 100 hours a week because it's not good for your overall well-being."
Most residency programs are in compliance with the new standards, according to the accreditation council. Since last July, it has reviewed 2,019 programs -- or about one-quarter of total programs -- and cited 5% for duty-hour violations. Nearly half of the offenses were for breaking the 80-hour week limit.
The accreditation council also allowed 75 surgical programs to extend resident work hours to 88 hours a week. So far, 53 doctors have filed complaints about work-hour breaches. Eleven cases were dismissed for lack of evidence.
The American Medical Student Association believes violations are underreported and says residents fear tattling could threaten their program's accreditation.
The association also found that medical students -- those not ready for residency -- are working more. Early results from a survey of 488 students found that half reported finishing clerical work for residents, and one-quarter said they completed clinical duties.
"It's no secret that changing residents' work hours does put a strain on the system in terms of staffing," said Brian Palmer, M.D., president of the medical student association.
Some residency programs have spent millions of dollars hiring nurses, nurse practitioners and physician assistants to fill shifts. Others rearranged schedules to create a "night float" rotation in which a team of residents arrives in the evening to relieve the early-bird workers.
The shortened work hours also have created friction between residents and some experienced doctors, who fear that today's physicians are not as dedicated to their jobs. But residency program directors believe the rift can be mended over time.
"It's getting worked out one person at a time, one day at a time," said Debra Weinstein, M.D., who oversees 1,500 residents at Massachusetts General Hospital and Brigham and Women's Hospital in Boston.