Internal medicine housestaff and attending physician perceptions of the impact of the New York State Section 405 regulations on working conditions and supervision of residents in two training programs.

OBJECTIVES

To assess the attitudes of internal medicine housestaff and their attending physicians regarding the impact of the reduction in on-call working hours and increased supervision mandated in New York by a revision of the State Health Code (Section 405).

DESIGN

Survey of senior medical housestaff and attendings two years after the adoption of the mandated changes.

SETTING

Two independent medicine housestaff training programs of the Albert Einstein College of Medicine in the Bronx, New York.

PARTICIPANTS

Fifty-three percent of third- and fourth-year residents (n = 79) and 60% of voluntary and full-time attendings (n = 266) responded.

MEASUREMENTS

A factor analysis of 13 variables that appeared on both versions of the survey identified two interpretable factors. A multivariate analysis of variance compared responses to each factor by group and by campus, and Bonferroni post-hoc comparisons analyzed the items within factors. Chi-square analyses compared responses of residents and attendings to the open-ended questions.

RESULTS

Significant differences between the housestaff and attendings groups were found for all fixed-response items (minimum p < 0.05 for all analyses), but both groups agreed that the regulations had a positive impact on resident attitudes regarding the demands on their time. Both groups were also uncertain whether the new regulations had a beneficial effect on the choice of internal medicine as a career, the quality of resident supervision, and residents' intellectual interest in challenging medical problems. Whereas residents agreed that the regulations diminished their fatigue, had no impact on their ability to observe the full impact of interventions on patients, and resulted in better patient care, attendings were uncertain or disagreed. While attendings agreed that the regulations had caused a shift-work mentality among residents, housestaff were uncertain.

CONCLUSIONS

Housestaff had more positive attitudes about the impact of the mandated changes in working conditions for residents than did attending physicians in the same institutions. The major benefits seen by residents were less fatigue and more spare time. There was no consensus about whether these changes had a positive impact on internal medicine practice and clinical supervision. There was some concern that a shift-work mentality is developing among residents and that continuity of patient care has suffered. Thus, despite some substantial benefits, Section 405 may not be achieving its goals of improving resident supervision and the quality of patient care by houseofficers.