The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program

Background: The Accreditation Council for Graduate Medical Education work-hour limitations (WHLs) were implemented in July 2003. Effects on resident wellbeing, patient care, and education are not well understood. We investigated these effects of WHLs. Methods: Self-administered survey of internal medicine residents in a university-based residency program in Seattle, Wash. Part of this survey was identical to one completed at our institution in 2001, permitting comparison of burnout, career satisfaction, and depression before and after WHLs. We surveyed 161 internal medicine residents, with 118 respondents (response rate, 73%). We measured resident well-being using the Maslach Burnout Inventory, a validated screening questionnaire for depression, and a previously described questionnaire for career satisfaction. We developed questions about overall agreement with implementation of WHLs and effects on resident well-being, patient care, and education. Results: Comparison with the 2001 survey demonstrated an increase in the proportion of residents satisfied with their career (66% to 80%; P=.02) and a decrease in the proportion meeting criteria for emotional exhaustion (53% to 40%; P=.05). Slightly more residents reported a negative effect of WHLs on patient care (37%) than they did a positive (29%) or a neutral (34%) effect, and more reported a negative effect on their education (47%) than they did a positive (32%) or a neutral (21%) effect. Overall, most residents (65%) approved of WHLs. Conclusions: Internal medicine residents approve of WHLs over all and report benefits to their well-being. However, they also report negative effects on patient care and resident education.