Comment on Optimum Working Hours for College of Physicians and Surgeons Pakistan Fellowship Residents of General Medicine and General Surgery Disciplines

By Sidra Waqar Qureshi, Erum Anwar

Affiliations

1. Department of Surgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan

doi: 10.29271/jcpsp.2025.07.943

Sir,

I recently went through the article by Ashrafi et al. on a rather important but infrequently discussed subject of optimum working hours for postgraduate trainees.¹ Although a limited number of residents were surveyed, it is high time that such matters be brought to light while considering the residents’ views. The effort is commendable, as it highlights some crucial aspects of the training programme, including the fact that inconsistent strenuous working hours compromise the acade-mic learning and study time of the under-pressure trainees.

Although both general medicine and surgery residents were included in the study, the results were combined, and a genera- lised view was presented. Since the surgery residents are generally known to work overtime,^2,3 owing to the long and unpredictable operation theatre (OT) lists, with more physical stress involved, would it not be better to separately group the responses by both physicians and surgeons?

Secondly, although the study was conducted in the third-largest public sector hospital in Karachi, only the abstract (but not the methodology section) mentions the surveying of hospital managers from the private sector, giving the gross impression that the results depicted are from the same hospital. This is important because hospital management in both the public and private sectors^4,5 deals with different challenges and interests. Similarly, the quality of training and number of trainees inducted yearly differ considerably, there-by, suggestions of relevant public sector authorities could have varied substantially.⁶

It is a dilemma that although CPSP’s Residency Programme suggests up to 72 working hours per week with single emergency duty,⁷ timings well beyond this recommendation have been reported,⁸ as there is no designated way of keeping a check to the conditions that the residents go through. Monthly on-call schedules depend on the number of trainees present at the time in an institute and vary in each department due to uneven distribution of supervisors and trainees by the concerned administrating bodies. Instead of increasing the workforce by increasing the number of inductees, more responsibilities are assigned to the already present residents despite remaining underpaid, thereby increasing workload and leading to more stress and burnout.

Hopefully, bringing such issues to light might lead to positive changes in the system, thus ensuring a more academically inclined and less exhausting training period.

COMPETING   INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’   CONTRIBUTION:
SWQ:  Conception  and drafting.
EA:  Drafting  of  manuscript.
Both  authors  approved  the  final  version  of  the  manuscript  to  be  published.

REFERENCES

1. Ashrafi SKA, Shaikh SU, Abbasi SZ. Optimum working hours for College of Physicians and Surgeons Pakistan fellowship residents of general medicine and general surgery disciplines. J Coll Physicians Surg Pak 2024; 34(2):217-21. doi: 10.29271/jcpsp.2024.02.217.
2. Kumar R, Siddiqui N, Shahid Z, Syed S, Kadir M. Stress, job satisfaction and work hours in medical and surgical residency programmes in private sector teaching hospitals of Karachi, Pakistan. J Pak Med Assoc 2012; 62(10):1109.
3. Riaz Q, Ali SK, Khan MR, Alvi AR. Stress and coping among surgery residents in a developing country. J Pak Med Assoc 2021; 71(1(A)):16-21. doi: 10.47391/JPMA.522.
4. Siddiqi S, Iqbal M, Aftab W. Review of the governance of public sector hospitals in Pakistan: Lessons for the future. World Hosp Health Serv 2019; 55(3):7-13.
5. Irfan SM, Ijaz A. Comparison of service quality between private and public hospitals: Empirical evidences from Pakistan. J Quality Technol Manag 2011; 7(1):1-22.
6. Khan AA, Shaikh S, Ahmed Z, Zafar M, Anjum MU, Tahir A, et al. Quality of post graduate medical training in public and private tertiary care hospitals of Karachi. J Postgrad Med Inst 2014; 28(1):13-8.
7. DNRP Booklet, College of Physicians and Surgeons, Pakistan (CPSP), 2019. Available online: DNRP_Booklet.pdf (cpsp.edu.pk). [Assessed on: 13/06/2024].
8. Zaheer F, Aziz I, Arif S, Khan MO, Khan AA, Osama M, et al. Predicament of doctors; discerning burnout level amongst surgical residents of Karachi, Pakistan. J Ayub Med Coll Abbottab 2020; 32(3):331-5.