On July 1, 2003, resident work-hour restrictions were imposed by the Accreditation Council for Graduate Medical Education. In this issue of the Bulletin, we highlight two studies that examine the effects of the 80-hour workweek on neurosurgical resident education. At the University of Oklahoma, both junior and chief residents were exposed to less volume of surgery following introduction of the restrictions. In the University of Utah study, the number of cases in which the junior residents were involved decreased 45 percent after the implementation of the work hour restrictions.
The reduced work hour rules were imposed without neurosurgical program directors’ input, and many do not agree with the changes implemented. Many residents, on the other hand, have welcomed the work hour limitations. What will be the impact of these changes on the practicing neurosurgical graduate? As noted by Martin and Wolfla, while it is apparent that many in our field do not agree with these rules, it is imperative that further study be carried out to ensure that trainees graduating from neurosurgical residency are competent.Further, while the issue of competency has been a concern for many program directors, no studies to date have objectively assessed the effect of such work restrictions on trainee technical competency. Will this limitation of experience affect competency, or will extra non-work-hour time be compensated by increased reading and hence knowledge of the resident? These questions should be the focus for careful analysis over the next few years. If the residency training will limit technical involvement and competency, then we must consider other alternative means for education, such as surgical simulation training. Alternatively, fellowship training will continue to propagate as a mechanism to develop competency in focused areas of practice.
As many neurosurgeons are contemplating practice restrictions, Richard N.W. Wohns, MD, has compiled a thoughtful analysis of the microeconomics of performing cranial surgeries. Individual neurosurgeons will be able to mirror this template analysis and consider the implications of ceasing performance of these procedures in the context of their own particular practice demographics, reimbursement patterns, malpractice premiums, and on-call responsibilities. These factors impact the profitability of cranial procedures, another of the many factors that must be considered when weighing the decision to restrict one’s practice.
Also in this issue is an overview of the Maintenance of Certification program put forth by the American Board of Neurological Surgery for rollout in January 2006. The key elements are published in the MOC handbook and are summarized in this issue of the Bulletin. MOC will be a foremost consideration for many neurosurgeons in the coming years. Neurosurgery has been one of the last medical specialties to adopt an MOC initiative, and we thank the ABNS and the many individuals involved with the question-writing committee for their efforts in the development of the MOC program.
William T. Couldwell, MD, is editor of the AANS Bulletin. He is professor and Joseph J. Yager Chair of the Department of Neurosurgery at the University of Utah School of Medicine.