Why Surgeons Struggle with Work-Hour Reforms by James E. Coverdill John D. Mellinger

Author:James E. Coverdill, John D. Mellinger [James E. Coverdill, John D. Mellinger]
Language: eng
Format: epub
Tags: Social Science, Disease & Health Issues, Medical, Surgery, General, Law, Medical Law & Legislation
ISBN: 9780826501073
Google: CHUTEAAAQBAJ
Publisher: Vanderbilt University Press
Published: 2021-01-15T02:49:11+00:00

Notes. An asterisk indicates differences by gender or years of experience are significant at the P < .05 level, as determined by a chi-square test statistic. Samples sizes for the group analyses differ slightly from the overall total due to non-response with respect to gender (four cases) and experience (twelve cases).

We begin by reviewing the overall results presented in the “total” column that is to the right of each question. The first three items explore professionalism and closely mirror what is commonly expressed by surgical societies. Nearly all surgeons agree that they should be responsible for the continuum of care for their patients (item 1 at 96 percent) and that they must accept inconvenience if it is needed to meet patient needs (item 3 at 97 percent). In this context, inconvenience is interpreted largely as needing to come in early, stay late, or return to the hospital. To a lesser but still substantial extent, surgeons believe that professionalism means “putting patients first” by subordinating their own self-interests (item 2 at 79 percent). Items 4 through 7 probe ways the reforms might conflict with professionalism. Large majorities believe that the reforms diminish familiarity with patients (item 7 at 82 percent) and encourage an unprofessional shift mentality (item 5 at 85 percent); few believe that the reforms fully support the practice of doing what is best for patients (item 6 at 17 percent). The results suggest widely held views and conflicts between the reforms and professionalism.

The final five questions (8–12) explore elements of change. For example, a few surgeons, in informal conversations and during the fieldwork, suggested that core professional values should change over time, and that professional values impose guidelines for behavior, not obligations. Item 8 suggests that about 27 percent of attendings agree that traditional ideals regarding “putting patients first” and “continuity of care” should change with the times. That minority view reflects a theme found in the interviews. It is also the first question that shows a statistically significant gap across levels of experience. While most believe that professional obligations often conflict with their family and nonwork obligations (item 11 at 79 percent), they are less likely to say that orientations to “work-life balance” conflict with the tradition of subordinating self-interests (item 10 at 34 percent). This latter issue prompts the only statistically significant difference by gender, and it produces a second and final divergence across experience levels. In our interviews, this view tends to blend with another, namely the need to take care of yourself before you can care for others (item 12).

Before turning to the interviews to further draw out forms of dissent, it is worth emphasizing a prevailing pattern: the results suggest shared views, not those that diverge often or sharply by gender or experience. Of the twelve items considered, gender mattered for one, experience for two. In a similar way, the dissenting views that we now turn to are not exclusively or even primarily championed by one or another sub-group of surgeons.

Dissent takes two main forms.

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