PAs make their mark in surgery.(News)

Definitive numbers are hard to find, but it appears that more hospitals are allowing physician assistants, nurse-midwives, and other midlevel providers to take over some duties from residents in the operating room.

The practice has been accelerated by the reduction in residents' work hours. In July 2003, the Accreditation Council for Graduate Medical Education said residents' work hours should be limited to 80 per week, and that continuous duty should be limited to 24 hours, with a 6-hour extension if needed for continuity of care or educational reasons.

In addition, residents should be on call in-house only once every 3 nights, according to the council's guidelines.

"It is reasonable to guess that when the 80-hour workweek restrictions went in, a lot of programs looked into ways of supplementing the service component of what residents do," said Roger Smith, M.D., chairman of the Council on Resident Education in Obstetrics and Gynecology Education Committee for the American College of Obstetricians and Gynecologists.

Dr. Smith said some of the surgical services that residents have provided may be of questionable educational value. In those cases, some hospitals have decided to shift the workload to people with the skills to perform the job who aren't under a restriction on hours, he said.

"Smaller programs with a busy service are a lot more likely to put in alternative ways to providing the care," said Dr. Smith, who is also program director of obstetrics and gynecology at the University of Missouri, Kansas City.

But Dr. Smith said there is no hard evidence that a significant shift has occurred.