There’s no doubt about it: professionals who are overworked and suffering from sleep deprivation are less efficient and more likely to make mistakes than those who work shorter hours and take time off between shifts to rest and recharge. This is why airline pilots, railroad engineers and commercial truck drivers all have caps on the number of hours they can work without time off.
However, when it comes to surgeon work hours, the concept of capping is much more controversial.
How Much Can Surgeons Work?
Beginning in 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited resident duty hours to no more than 80 hours of work per week, no more than 24 consecutive hours of duty, one day off per week and at least 10 hours off between shifts.
However, once a surgeon has completed residency and become a practicing clinician, these rules no longer apply. In other words, an attending physician can work as much as they’d like.
How Do Capped Hours Affect Surgeons’ Well-being and Patient Safety?
Advocates for capped hours argue limiting resident duty hours increases well-being and promotes better job satisfaction. However, even with caps in place, residents still suffer high rates of professional burnout and depression, according to an article published by the American Medical Association.
“When I was trained in the 1980s, it was a sign of weakness not to say that you loved the every other night in-house call, the sleep deprivation and no time to do anything else,” says Dr. Julie Ann Freischlag. “We were maintaining the image of being tough.”
While advocates also posit limiting surgeon hours could ensure better quality of care for patients, others disagree, arguing that a disruption in continuity and too many patient handoffs could lead to medical errors.
Two studies, one conducted by experts at the University of Pennsylvania and another led by researchers at the American College of Surgeons and Northwestern University, found the work-hour limits enacted by the ACGME had no effect on a patient’s risk of death or readmission, according to an article published in the Los Angeles Times. And while less time on the clock should theoretically mean more time to study for board exams, studies found no significant difference between pass rates before and after the ACGME’s new rules.
What’s the Answer?
Deciding to cap surgeon work hours is a complex issue that should be examined from many angles. While working fewer hours might improve work-life balance, less time in the operating room also means less experience, which could also impact quality of care.
Plus, even with capped hours, the issues of surgeon burnout and depression remain. So rather than enforcing strict rules around hours, it may make more sense to create better processes for checking in on surgeons’ mental health, better resources for intervention and prevention of burnout and fatigue and continued investment in the tools and technology that help surgeons work more efficiently.
If surgeons can better self-identify when they need to take time away from the operating room, and they’re supported by a culture of understanding, hour-capping might not be necessary at all.