Some days, Dr. Kristofer Dosh is grateful to see dawn come. After working all night at Lansing's Sparrow Hospital, the second-year medical resident knows he'll soon be able to crawl into bed.
Other days, Dosh hears his alarm and knows the light of day means another long, grueling schedule. Rays barely peek through the hospital windows when Dosh begins sorting out his duties for the day.
But every day, he knows he's lucky to be conducting his residency under today's standards. Decades, even years, ago, Dosh's 65-hour work week would've seemed light.
"It used to be that 80 hours a week was a light load," said Dosh, a 28-year-old who works in internal medicine. "Sometimes, the work would add up until residents were working 110 or 120 hours per week in a hospital, working through the night and trying to catch a few minutes of rest at the hospital.
And he should know - Dosh is a third-generation doctor. His grandfather worked as a doctor of osteopathic medicine in family practice and his father still is working as an internal medicine physician. His younger brother attends medical school in Wisconsin and his wife is a student in MSU's College of Human Medicine.
"There's a whole clan of us Dosh doctors," he said. Now, the regulations limiting Dosh and other residents to an 80-hour work week are enforced by the Accreditation Council for Graduate Medical Education.
"Many physicians of prior generations view the restrictions negatively. They suffered endless hours and unacceptable work conditions for many years and believe that today's residents should experience the same."
Dr. Steven Dosh, Kristofer's father and a 1976 MSU medical school graduate, said he's relieved his sons don't have to suffer the same struggles as he did.
"Kristofer's high-end hours were my low-end hours," he said. "Sometimes, we'd begin work Friday morning around 8 a.m. and work straight through 'til Monday evening."
The elder Dosh remembers being frustrated as Kristofer grew up without him as a steady figure in the child's life.
"Kristofer was just a little one. He'd just get to start to feel comfortable with me, and I'd get called away and, when I came back, it was like I was a stranger again.
"You're going through this roller coaster."
Dosh expressed surprise that both his sons elected medicine as their chosen profession. Still, his own father, who was a physician in the Flint area, inspired Steven Dosh's career.
"His enthusiasm for medicine was what eventually drew me in," Steven Dosh said. "I can't imagine any job that's better - even with the hours."
Rotating routines
Regulations were put in place limiting working hours for residents across the nation last year. Now, less than a year later, the council is considering increasing the work load again.
Still, just because the work weeks have to average out to 80 hours doesn't mean Dosh doesn't spend 90-hour weeks in the hospital, sometimes working 30-hour shifts.
"Maintaining balance is a challenge," he said. "With my wife also in medical school, we're sometimes hard-pressed to find time together."
At the beginning of an average shift, the residents gather together to divy up the patients for their work period.
Each group consists of two first-year medical residents, a second-year senior resident and an attending physician.
"My job is to make sure things are running smoothly," said Dosh, who plans to stay on for a fourth year as a chief resident - a year that is optional under MSU's three-year Internal Medicine residency.
Patients who come in overnight are divided up among the residents.
"Most patients come in through ER," he said.
From 8 to 9:30 a.m., the residents go on rounds to visit patients.
The doctors spend an average of 12 to 15 minutes with each patient, but they also confer about the patient's case before and after the consultation. More time is spent considering the patient's diagnosis and treatment.
In that 90-minute time span, the residents are allowed no more than 24 patients total.
"You'd start missing things when the patient load is too high," he said. "I think a lot of patients perceive that we don't spend as much time as we do."
Sparrow Hospital might have to begin finding ways to compensate for the work MSU residents currently do because of a pending plan that would move a large portion of the College of Human Medicine to Grand Rapids.
Sparrow Hospital officials have said it could hurt the way the hospital runs. Under that plan, about 25 first-year and 25 second-year students will be staying in Lansing.
Behind the scenes
According to the Institute of Medicine, nearly 100,000 annual deaths result from medical errors, and more than 41 percent of residents attribute their most serious mistakes to fatigue.
In order to start combating those kinds of mistakes, U.S. Rep. John Conyers Jr., D-Detroit, introduced the Patient and Physician Safety and Protection Act to Congress last November.
The act would change the way Dosh and other residents across the country spend their time. The act would limit residents to an 80-hour work week, limit shifts to 24 hours with at least 10 hours between shifts and include at least one day off in a seven-day period and at least a full weekend off every month.
But less than a year after the accreditation council put stricter regulations into place, it is considering modifying work-hour restrictions after some residency program directors said more hours were necessary for a proper education. The council also is reconsidering the 10-hour rest period following in-hospital calls.
Dosh, however, said restricted hours have allowed him only a better residency experience.
"Patient care is clearly made safer by forcing residents to rest," Dosh said. "And time restrictions also enhance our education by allowing us time to actually study the patient cases we are confronted with. No longer must we learn purely from knowledge passed down by mouth, but we actually have time to review scientific literature and improve patient care by the knowledge we retain."
The American Medical Student Association, the nation's largest association of doctors in training, is frustrated with the new work hours being considered.
"Less than a year after introducing the regulations, it is outrageous that the ACGME is considering an increase," association President Dr. Lauren Oshman said. "Residency programs can find innovative solutions to both reduce work hours and improve patient safety at the same time."
Tara May is the State News health and religion reporter. Reach her at maytara@msu.edu.
