Imagine that your boss stopped you and said, “We are now increasing your workweek to 80 hours and, sometimes, to 120 hours. Sometimes you will have to work 36 hours straight. And lest I forget – you’ll only be paid for 40 hours.” That’s right – you would be paid for only 40 hours. There would probably be a lot of upset workers – and that’s putting it mildly.
But this is the situation “physicians in training” face. They are called “residents” but, nonetheless, they are practicing physicians who make life-and-death decisions.
According to experts, surgical residents, as well as those engaged in obstetrics and gynecology and family medicine, work the longest hours. Medical centers in Boston reportedly expect their residents to work up to 120 hours per week.
Prior to World War II, physicians were still considered students when they embarked on a one-year internship followed by a two- to four-year residency in a specialty. They were treated like apprentices in the building trades, except that these workers were paid. The analogy is not that far-fetched: The rationale for these long hours is the need for repetition – for practice, practice and more practice.
It wasn’t until interns and residents organized into labor unions in the late 1960s that they began to be paid. Before then they only received room and board for their services. Nursing training in a hospital setting, sometimes known as “diploma” nurses, also received only room and board. Communists were among the activists who organized these physician unions.
Recently the Committee of Interns and Residents joined the Service Employees International Union (CIR/SEIU), which now represents about 10 percent of the nation’s 120,000 residents. Today these unionized physician-workers receive a living wage and do not work more than 80 hours a week.
Every two or three years there are exposés of the harmful effect of these excessive work hours. But too often they lead nowhere. But now the Accreditation Council for Graduate Medical Education has enacted an 80-hour limit. This action took place at the same time that Sen. John Corzine (D-N.J.) and Rep. John Conyers (D-Mich.) introduced legislation to make these essentially voluntary restrictions a federal law.
Physician activists, who are seeking a reduction in hours, report that pressure from accrediting agencies is not very effective and state laws are not being enforced. Simply put, there are not enough physicians.
Limiting access to becoming a physician is as old as limiting plumbers, electricians and others to the construction trades in order to keep their demand high. But heath care is not construction and cannot be left to those market forces. Expansion of the number of physicians is a major necessity and its solution is simple: Provide free tuition in return for commitment to serve in needed communities, and that can be done by expanding the U.S. Public Health Service.
We need to double the number of doctors we now have, not limit its growth. By doing that, we can cut down on the ridiculous 80 hours of work in a week to the hours that everyone else is working. By dramatically increasing the number of physicians the country can get doctors to work in rural and urban areas that are in dire need of care. The next step is enactment of a national health service that can finance the whole system.
The author can be reached at pww@pww.org
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