CORR Insights: Orthopaedic Residency Applications Increase After Implementation of 80-hour Workweek

Abstract

This CORR Insights TM is a commentary on the article ''Orthopaedic Residency Applications Increase After Implementation of 80-hour Workweek'' by Anakwenze et al. available at DOI 10.1007/s11999-013-2785-1. Where Are We Now?There has been much interest in the effects of the 80-hour workweek on resident performance, lifestyle, and education. As Anakwenze et al. note in this article, there have been conflicting data and opinions regarding whether the work-hour restrictions have achieved their intended results of decreased medical error, increased patient safety, and improved resident performance and satisfaction. Similarly, it has been hard to prove or disprove whether the 80-hour workweek has had negative ramifications on the breadth, depth, and quality of resident education and experience. Even harder to study and quantify is the question regarding whether work-hour restrictions have negatively impacted the socialization of residents, by having diluted residents' sense of ownership and responsibility for their patients, interrupting continuity of care, and fomenting a ''shiftworker'' mentality. There also has been much interest in factors that influence medical students' choice of residency. Two studies found that ''controllable lifestyle'' is the single most important factor, especially for women [5,6].Where Do We Need to Go?Anakwenze and colleagues examine the relationship between implementation of the 80-hour workweek and the number of applications to orthopaedic residencies. The results showed a 21% increase in orthopaedic residency applications after the work-hour restrictions, which the authors attribute, at least in part, to medical students' perception of an improvement in the lifestyle of orthopaedic residents. They found a concomitant 18% decrease in applications to primary care fields, and speculate that in essence, the work-hour restrictions level the playing field between residencies traditionally perceived as more strenuous, and those regarded as less demanding. Of course, choice of residency is multifactorial, as evidenced by the 24% decrease in applications to general surgery during the course of the study. We evaluated medical students in the class of 2008 at the University of Nebraska; at the beginning of each year, we asked them about their choice of residency, and contacted them again after the Match. Our response rate was low, (29%), but we found that 65% of respondents changed their minds during the course of the 4 years. A negative perception of residency lifestyle was the only statistically significant factor in the decision to make a change. Interestingly, none of the three students whoThe author certifies that he, or a member of his immediate family, has no funding or commercial association (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Factors influencing the number of applications submitted per applicant to orthopedic residency programs

“…The highly competitive nature of the orthopedic surgery application process and the perceived need to interview at 12 programs or more to have a >90% chance to successfully match have presumably contributed to the increasing number of applications submitted. In addition, other studies have suggested that the implementation of the 80-hour work restriction has led to an increase in applications ( 8 , 9 ). The NRMP and others have previously reported on factors such as class rank, USMLE 1 scores, and the number of publications that correlate with a successful match.…”