If Dr. Ezekiel Emanuel gets his wish, tomorrow’s physicians won’t deserve to be paid as well as physicians today because they won’t be as well trained.
Dr. Emanuel, a brother of Chicago Mayor Rahm Emanuel and a chief apologist for the Affordable Care Act, is the lead author of a startling opinion column in the March 21 Journal of the American Medical Association. He argues that there is “substantial waste” in the current medical education system, and—in a time when medicine gets more complex every day—advocates cutting the training period for young physicians by no less than 30 percent.
Dr. Emanuel’s plan would reduce both the time spent in medical school and in residency training, which (as every physician knows from experience) is the period of three to seven years that a new graduate physician spends learning to practice a specialty.
Many people don’t realize that residents already receive less training than they used to, because stringent limits have been set on the amount they are permitted to work. Since the duty hour rules were rewritten in 2003, residents are limited to 80 hours a week in the hospital, which includes overnights on call when they may be asleep (what the rules refer to as “strategic napping”). First-year residents, or interns, as of 2011 aren’t allowed to work more than 16 hours at a stretch.
Many senior physicians are concerned that today’s residents aren’t seeing enough patients. Evidence suggests that board examination scores are on the decline in fields from neurosurgery to pediatrics, as reported in the Accreditation Council for Graduate Medical Education (ACGME) Bulletin in 2009. The American Board of Internal Medicine reports that the passing rate for first-time exam takers slipped from 94 percent in 2007 to 87 percent in 2010. Unfortunately there’s no evidence that residents are using their increased off-duty hours to pursue either knowledge or sleep. There’s no proof that patient care has improved, or that medical errors are fewer.
Now Dr. Emanuel thinks that even this amount of training is too much.