Working hours and work-load
It was common for residents in clinical medicine to remain at work for long stretches with minimal or no sleep. Concerns with regard to safe practice were raised, particularly with regard to the surgical specialties, including obstetrics, and the emergency room. The American Medical Student Association represents more than 30000 physicians-in-training at over 150 U.S. medical schools, and one of its former presidents is quoted as saying "It is clear that we need a work force of alert and cognizant physicians...Patients...deserve to be seen by professionals who are at their best." Medical students, physicians and consumer advocates therefore supported legislation to change the situation and to protect public safety. This led to passage of The Patient & Physician Safety and Protection Act of 2001, which sought to reduce the working hours and to address resident supervision. The Accreditation Council for Graduate Medical Education now stipulates that duty must not exceed 80 hours per week, averaged over a 4-week period. Residents must also have one continuous 24-hour period in 7 days free from all educational and clinical responsibilities, also averaged over 4 weeks. They are also required to have adequate time for rest and personal activities, consisting of a 10-hour time period between all daily duty periods, and after in-house call. Limitations are also placed upon on-call activities. These stipulations were designed to protect the public and to diminish resident stress.
I know of no anatomic pathology program in which residents venture near 80 duty hours a week. Anatomic pathology residents do not work in the hospital through the night on anything approaching a regular basis. There may be some late frozen sections but these usually occur well before midnight. From time to time, a call will be received in the early hours of the morning, but this does not put a pathology resident into a chronically overworked state. The application of the working hours should be adjusted for this specialty.
As a related matter, if we accept that patients deserve to be seen by residents at their best, then that expectation must surely be applied to qualified pathologists, who shoulder large slide volumes that must be scrutinized at a constantly high level of acuity. Whereas a resident who has been up at night may get the next morning off, the pathologist who supervises a frozen section at 3:00am is expected to arrive at 8:00am at his or her professional best. Were the government to legislate limitations on the number of slides that a surgical pathologist is permitted to examine in a continuous period, turnaround time would increase, and there would be an outcry. Maybe, however, certain errors would decline, and perhaps academic pathologists would be better able to spend more Time productively with their residents.