Hal Scherz

Physicians like me, who train young doctors in residency and often hire them to join a private practice, have made two observations over the last several years - they are smarter than ever, but they come out of their training programs less qualified to take care of patients than any group of freshly minted doctors that preceded them.

This is a serious problem because as older doctors retire, the younger ones replacing them cannot simply be plugged in to fill the void. The problem is even graver because as reported by Deloitte in its 2013 survey of doctors, 60% of physicians contemplated early retirement in the next 2-3 years. This can be attributed almost entirely to onerous government regulations resulting from the Affordable Care Act (ACA, Obamacare).

The diminishing abilities of recently trained doctors can be directly correlated with limitations in hours spent doing direct patient care in the hospital. In the most recent edition of the Journal of the American Medical Association, Desai and Associates reported the results of a randomized, prospective study that examined this issue. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented significant restrictions regarding on duty hours. Interns (first year trainees) could not work more than 16 consecutive hours, and must not have in hospital duty more often than every third night. Additionally, shifts were encouraged to limit the amount of consecutive hours on duty.

Desai took a group of internal medicine residents and subjected them to the new regulations, while another group worked longer hours. The residents who worked less were shown to have fewer educational opportunities, less continuity of patient care and were delivering worse quality of care. The residents who complied with the new workplace regulations had significantly fewer patient encounters and less exposure to their professors and mentors. Although this study examined trainees in internal medicine, it can be theorized that the problem would be even worse in the surgical fields, where repetition is a critical element in training.

Hal Scherz

Dr. Hal Scherz is the Chief of Urology at Scottish Rite Children's Hospital in Atlanta and Secretary of the Docs 4 Patient Care Foundation.