Lay down your scalpel, it's nap time!

E.B. Solomont (formerly of the Forward, as it happens), writing critically in Slate about the Institute of Medicine's work hour report, observes hyperbolically

Surgical residents may someday soon have to prepare themselves to halt an operation and announce that it's nap time.

Solomont doesn't know that surgeons often must hand off care during a long procedure (colectomies can last forever)?

The Royal College of Surgeons (one of the organizations named by Solomont as opposing stricter work-hour regulations) provides a summary of their recommendations regarding training modifications. After a thorough review of work patterns in the context of impending regulations (or after they had already been instituted; it's not clear to me), the following findings became (magically?) apparent:

• a significant reduction in the need for acute surgical intervention (except for life- or limb-threatening conditions) between 22.00 and 08.00
• the majority of work undertaken by surgical staff during this period relates to the management of medical co-morbidities

Do you think that these shocking facts would have made themselves known without the threat of regulatory penalty?

The report also mentions a number of possible solutions. Leaving off for a snooze during the middle of a heart bypass is not mentioned, but scheduling innovations are.

Surgery and medicine training programs are naturally going to squawk at work hour regulations, and it's a tradeoff between continuity of care and well-rested residents. But it's also a myth that every hour of time spent at the hospital means another hour spent in quality medical education. Hiring physician extenders doesn't mean depriving housestaff of the opportunity to see interesting patients and learn necessary procedures. Often just the opposite is the case.

Speaking of naps, many sleepless surgeons have already taken a few - but in the OR, browning out over the field, not at home. Which would Solomont prefer?