A poll asking whether surgeons and others delivering care in the operating room (OR) should have caps on their hours found a large divide on the subject between physicians and nurses.

Answering the first question in the poll, which was first posted on July 18, about whether surgeons' hours should be capped to reduce harmful mistakes, 57% of physicians and 87% of nurses and advanced-practice nurses (APRNs) said yes. Ten percent of physicians and 9% of nurses were unsure.

A much larger percentage of nurses/APRNs than physicians also said that others' hours in the OR (such as those of nurses and anesthesiologists) should be capped (89% vs 62%).

The caps for surgeons.

The poll followed a Medscape story about an editorial by C. Niek van Dijk, MDpublished in the Journal of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, which supported the caps for surgeons.

Van Dijk made the comparison with airline pilots and train drivers whose work hours are carefully monitored and noted that these professions have drug and alcohol testing. "Why are not we surgeons monitored and similarly prevented from overworking?" van Dijk asked.

"Are we assumed to be morally superior because of our Hippocratic Oath? Or is it because we can only damage the occasional patient if we are exhausted, rather than an entire planeload?" van Dijk asked.

An orthopedic surgeon who also commented on that story said the comparison with pilots is unfair. The surgeon wrote: "Pilots really can be swapped out at any point — even mid-flight because there is a co-pilot. 

"Who can afford to pay two surgeons to do a case that one can do alone? Who would be willing to? "Patients don't want to think that their surgeon could possibly leave in the middle of their procedure. It's not part of the profession. We do not keep bankers' hours because we are not bankers."

How Do We Monitor Impairment?

Another surgeon who responded to the poll wrote: "There is little doubt that limiting work and monitoring for impairment will decrease errors. However, how many limitations and what exactly and how do we monitor impairment, a priori?"

Another question in the poll asked whether surgeons should be routinely monitored for negative behaviors, such as substance abuse, that could potentially affect their work. Again, a much higher percentage of nurses/APRNs than physicians answered yes (82% vs 62%).

Similar numbers answered yes when asked whether others in the OR (such as nurses and anesthesiologists) should be routinely monitored for negative behaviors (82% of nurses/APRNs said yes vs 64% of physicians).