Persistent noncompliance with the work-hour regulation

Objective: To investigate the reason for noncompliance with the work-hour regulation by surgical residents. Design: Nationwide anonymous survey (November 1, 2007, to March 1, 2008). Setting: Academic center. Participants: Surgical residents throughout the United States. Main Outcome Measures: Incidence of noncompliance remains high and reasons for noncompliance are multifactorial. Results: The first 141 questionnaires returned were included in this analysis. Responders consisted of postgraduate year (PGY)-1 (32.6%), PGY-2 (19.1%), PGY-3 (17.7%), PGY-4 (13.5%), and PGY-5 (17.0%) surgical residents. Many residents were categorical (79.4%), male (61.7%), and married (53.2%). Ninety-eight percent of residents were aware of the work-hour regulation, with 72.1% of residents in favor of it. However, noncompliance with the work-hour regulation was 64.6%, with 21.1% of residents working more than 90 h/wk (average, 86.6 h/wk). The most problematic regulations to follow were "at least 10 hours of rest between duty hours" (36.9%), "24-hour limit of continuous care plus 6 additional hours for continuity of care and educational objectives" (26.1%), and "80-hour work limit over 4 weeks" (22.7%). Education and continuity in patient care were the main reasons associated with noncompliance. Non-compliance was highest in trauma (25.2%) and vascular surgery (16.3%) residents. In addition, 65.2% of the attending physicians do not agree with implementing workhour regulation standards in the surgical faculty. Conclusions: The survey demonstrates that noncompliance with the work-hour regulation is prevalent. The reasons for noncompliance are multifactorial. These findings will help restructure training programs in the efforts to increase compliance with the work-hour regulation.