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 2 TRAINING-PROGRAMS

Objectives: To assess the attitudes of internal medicine housestaff an d their attending physicians regarding the impact of the reduction in on-call working hours and increased supervision mandated in New York b y 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 B ronx, 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 interpreta ble factors. A multivariate analysis of variance compared responses to each factor by group and by campus, and Bonferroni post-hoc compariso ns analyzed the items within factors. Chi-square analyses compared res ponses of residents and attendings to the open-ended questions. Result s: Significant differences between the housestaff and attendings group s were found for all fixed-response items (minimum p < 0.05 for all an alyses), but both groups agreed that the regulations had a positive im pact on resident attitudes regarding the demands on their time. Both g roups 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 challen ging medical problems. Whereas residents agreed that the regulations d iminished their fatigue, had no impact on their ability to observe the full impact of interventions on patients, and resulted in better pati ent care, attendings were uncertain or disagreed. While attendings agr eed that the regulations had caused a shift-work mentality among resid ents, housestaff were uncertain. Conclusions: Housestaff had more posi tive attitudes about the impact of the mandated changes in working con ditions for residents than did attending physicians in the same instit utions. The major benefits seen by residents were less fatigue and mor e spare time. There was no consensus about whether these changes had a positive impact on internal medicine practice and clinical supervisio n. There was some concern that a shift-work mentality is developing am ong residents and that continuity of patient care has suffered. Thus, despite some substantial benefits, Section 405 may not be achieving it s goals of improving resident supervision and the quality of patient c are by houseofficers.