Should Medical Residents Work Fewer Hours?
By: Cohen, Placitella & Roth @ Jun 24, 2016
For centuries, medical residents have been expected to work gruelling hours, as many as 90-100 hours a week, with shifts of up to 36 hours at a time. The federal Agency for Healthcare Research and Quality’s Patient Safety Network (PSNet) notes that these hours have been considered by many to be a rite of passage, and necessary to adequately prepare future doctors for clinical practice. Only since the 1980s has any attention been paid to the effect such demanding work schedules have on patient safety and resident well-being.
In 2003, the Accreditation Council for Graduate Medical Education limited resident hours to no more than 80 per week. Subsequently, in 2011, the Council limited shifts for first-year residents to 16 hours. These changes have been controversial, and studies show mixed results.
Mixed results from limiting resident hours
According to PSNet, a 2011 systematic review found that after the 2003 hours limitations were implemented, resident well-being improved. But there was no clear effect on patient safety or clinical outcomes. In fact, any potential patient safety benefit from having better-rested residents might be negated by the increased need to hand off patients from one clinician to another, which could increase opportunities for error in patient care. Other research has shown that duty hour regulations appear to have adversely affected residents’ educational experience.
A New York Times blog post notes that evidence is mounting that doctors in training increasingly experience serious mental health issues. Recent studies show that:
- one-third of residents show symptoms of depression; and
- almost 10 percent of fourth year medical students, and 5 percent of first-year residents, admitted to having had recent suicidal thoughts.
The Times blog also points out that it is unclear whether more limited hours will help either residents or patients.
New trials study the effects of longer and shorter shifts
According to the Times, two new national trials are hoping to shed light on the question. Researchers in these trials selected first year residents at random from general surgery or internal medicine programs throughout the country to work either 16-hour shifts (the current maximum) or longer shifts (28 hours or more). These trials provoked the ire of two advocacy groups, who objected that the longer hours potentially caused greater risk to patients from sleep-deprived residents, and greater risk to the residents themselves. The trial involving surgery residents, known as First, released results in early February 2016. The Times reports that the study found no significant differences in patient outcomes, resident satisfaction, or educational quality when residents worked longer shifts.
Looking at all this research, the Times blog suggests that clinical data, while important, may be of only limited usefulness in considering questions of patient care and resident well-being. The quality of a resident’s relationship with patients, like a resident’s personal sense of well-being, is not susceptible to being measured by patient care metrics like mortality, procedural events, mortality, and readmission rates. The ultimate answer, according to the Times, may be as much a question of philosophy as of science.
Consult a Philadelphia medical malpractice attorney
Philadelphia is home to many university hospitals. Inevitably, staff mistakes and oversight lead to accidents which can harm patients. If you or someone you love has been hurt by a healthcare professional’s negligence, contact the skilled Philadelphia medical malpractice attorneys of Cohen, Placitella & Roth, P.C. for a consultation today.