Doctors as workers: work-hour regulations and interns' perceptions of responsibility, quality of care, and training

To study residents' perceptions of their responsibility for patients, the quality of patient care, and their learning experiences in light of new work-hour regulations.

Inductive analysis of in-depth, semistructured, recorded interviews with a cohort of interns in internal medicine in the last month of their first postgraduate year. Questions were grounded in an examination of issues related to going off duty and delegating tasks to colleagues. Transcripts were independently analyzed by an interdisciplinary team.

New York University/Bellevue Hospital Center's residency program in internal medicine (in New York City).

A cohort of 21 of a possible 24 interns in medicine on rotation at Bellevue Hospital Center.

The interviews revealed: 1) intense concern harbored by interns for their patients with resulting difficulty in maintaining realistic boundaries between work and personal lives; 2) an open-ended workday and competing considerations confronting interns when deciding to leave the hospital--including concerns about leaving patients at critical junctures in their care, confidence in the colleague to whom they were signing out, regard for the workload of this colleague, and uneasiness about the educational consequences; 3) deterrents to acknowledging and acting on one's limits in performing medical work; and 4) a recurrent conflict between delegating responsibility and retaining control over patient care.

Values traditionally learned in training emphasize autonomy and individual accountability. They may conflict with the shared decision making and collective responsibility among peers necessitated by work-hour limitations and associated changes in program structure.