1438. Time Warp - Flagrant Disregard of the 80 Hour Work Week in Neurosurgical Residencies

Authors: Gary Robert Simonds, MD, FAANS; Cara Rogers; Chris Busch; Brendan Klein (Black Mountain, NC)

Introduction: Most nerurosurgical residencies are bound by prescriptive ACGME directive to limit mandated resident work, both on campus and off, to less than 80 hours per week. We suspected that this directive, despite reported results in ACGME resident surveys, is broadly disregarded. Methods: Through interactions at a series of courses, meetings, and program visits, we "straw-polled" and/or interviewed over 100 recent graduates from neurosurgical residencies and over 75 current residents from dozens of programs. We asked principally whether the 80 hour rule was, within reason, adhered to in their training programs. If not, we asked respondents to estimate the number of hours they worked in-hospital during a typical week. We also asked respondents to estimate the number of hours they dedicated to their work and training when home in the evenings. Results: Recent graduates and current residents almost uniformly reported near-constant infraction of the 80 hour rule. More then half reported typical work weeks of over 100 hours. This appeared to be a worse phenomenon during the early years of training. Many admitted to purposeful mis-registration of work hours to the ACGME. In addition, the majority of residents reported dedicating an additional 2-3 hours of time to their work and/or training each evening; many reporting continuing to enter materials into patient charts through remote links to the electronic medical record. Conclusion: This is concerning. Clearly this is not a well-validated study. But it does suggest that the ACGME 80 hour work directive is widely infracted in a large number of our training programs. The implications for resident resilience and wellness could be profound, not to mention the culture of dishonesty and cynicism it promulgates. We need a formal de-identified survey of this phenomenon and potentially much more strident oversight of resident work hours in neurosurgery.