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Scheduling Surgery Residents

Explore the impact of new rules limiting work hours on residents in medical education, scheduling challenges, and the controversy surrounding work rules and conditions. Learn about the complex formulation for creating resident schedules and the potential criticisms faced.

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Scheduling Surgery Residents

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  1. Scheduling Surgery Residents • New rules limit work hours • Scheduling problem • Interesting context

  2. Medical Education in the US • Bachelor (4 years) • Medical School (4 years) • $42,974/year tuition at Northwestern • Residency • 3-7y, 5y for general surgery • paid (first years: $48,270.96 at Northwestern) • Fellowship (subspecialties)

  3. Residency • Training of doctors • Cheap labor • Funded by Medicare • “If you have one less nurse, then you've saved $40,000. If you have one less resident, you've saved $40,000, but you've lost $100,000 in reimbursement.” • Limited supply • The “Match” and the “Scramble” • Working conditions

  4. Work Rules • NY State Libby Zion law (1989) • From accreditation body (ACGME, 2003) • Work week ≤ 80 hrs (over averaged over 4wks) • ≤1 on call night every 3 days • 30 hr max shift • 10 hr between shifts • Routinely flouted • Does not apply to fellows • Controversy • Reducing medical errors • Getting necessary medical training

  5. Scheduling Problem • Hospital’s (cheap labor) perspective • How to cover various areas • Rotations in Duke hospital, and • Nearby hospitals • Without violating the law

  6. Formulation • Seeking a schedule for a week • MIP feasibility problem • I = set of residents • J = services to cover • Includes other hospitals • Includes time-off • K = set of 4 hr time slots • xijk = 1 if resident i covers service j at time k • binary

  7. Formulation • zij=1 if resident i does rotation j (binary) • ∑j zij ≤ 1 (at most one rotation in a week) • ∑k xijk ≤ 20zij (80 hrs/rotation limit) • ∑j xijk ≤ 1 (one thing at a time) • ∑ik xijk ≥ 1 (at least one available at each loc) • 2xi,11,k+xi,11,k+1+xi,11,k+2 ≥ 2xi,11,k-1 (breaks ≥ 12hr) • …

  8. Sample Result • 1st year resident in trauma rotation • Schedule • Monday 6am to Tuesday 6am • Tuesday 6pm to Wednesday 6am • Thursday 10am to Friday 6am • Saturday 6am to Sunday 2am • 76 hours total

  9. Criticism • A year is scheduled at a time • Educational component? • Ensuring coverage not a compelling constraint • Hospital could hire more • Residents • Doctors

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