residency hours

Clearly, it's too early for me to be thinking about how long residents have to work, but the topic has been floating around my world often enough that it deserves my 2 cents. For the uninitiated, recent trends in American medical education have begun to limit resident work hours to 80hrs/week with some restrictions on 24 hr shifts and various other things. One of my upperclassmen was talking today about how surgical residents that she knew at MGH essentially under-report the hours they work per week by something like 10-30 hours (by the way, this is illegal). These residents apparently under report for fear of departmental backlash from program directors who would like their residents to work more than 80 hours (like back in the good old days) but legally have to follow the new laws. The monitoring board for this sort of thing has investigated programs that violate the law (for instance, Johns Hopkins was recently investigated--I don't know the specific residency program). Johns Hopkins, MGH...these are top places for residencies, especially for surgery. Is this the price for top trained doctors?

The controversy beckons the question: what is really at stake here? Is it resident training (surgical program directors argue that the training for surgery necessitate residents working over 80, even 100 hours in order for them to be trained adequately to take care of patients from A to Z) or is it patient safety (my impression is that there is a correlation between higher risk for patients with overworked residents making mistakes)? I know that the culture of medicine is slow to change, but at high powered and high stake places like MGH, what is truly going on? My understanding from the resident's perspective is that for some, they WANT to work more than 80 hours if it takes that much for them to take care of patients 'properly' and the new laws are compromising their superior training as physicians. For others, the requirement places them in a tight spot, especially if their program directors implicity want them to work over the limit, but by working over the limit they are legally held more responsible for their mistakes, and reporting the whole thing would mean being ostracized by their fellow doctors, perhaps even damaging their future career developments.

What depresses me the most is hearing/reading comments from surgical directors/ older surgeons who says essentially that students not prepared for this kind of work hour should choose another specialty or get out of medicine altogether. Mind you, I think this sentiment is rare, but nonetheless before the rules were applied surgical residencies were legally allowed to work you to death. 100-120 hours of work a week border on cruel and unusual punishment if you ask me, especially considering how a week only has 168 hours in it! It worries me that at the top training facilities in this country for surgeons, the cultural mentality of overworking residents still exist, and the peer pressure to interpret more hours as better training is still being encouraged. What kind of logic is operating if residents are asked to work without sleep, thus committing more errors and possibly compromising patient care so that they can be better physicians later on (to serve a richer clientele) because the patients they practice on now are generally poor?

If the aforementioned is a myth, I'd love to find evidence to debunk it before I have to choose residencies. I really do.