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Study: Does Limiting Residency Work Hours Affect Performance?

By Anna Mueller, MS16 Sep 2019

Long shifts and little time off have always been associated with healthcare professions — specifically physician training. For many new medical practitioners, sleepless nights and holidays on-the-clock feel like a right-of-passage.

In recent years, healthcare organizations have taken a closer look at doctor schedules with some even enforcing hour restrictions. And while there’s no doubt working shorter shifts can help stave burnout and improve work-life balance, many wonder if capping GettyImages-1010601644residency work hours improves patient outcomes? 

Not necessarily, according to a new study published in The BMJ.

Here’s an overview of the findings and insight into why many physicians don’t support fewer hours.

How Work Hours Impact Quality and Cost of Care

After mounting concerns over patient safety, the Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour restrictions. The 2003 regulations limited residents to an 80-hour work week and maximum 30-hour shifts. In 2011, first-year residents were further limited to working no more than 16 consecutive work hours at a time.

To determine whether these restrictions affected patient outcomes and cost of care, the 2019 study compared outcomes of patients treated by first-year internists exposed to the work hour reforms with those with partial to no exposure to those changes. They also included a control group of doctors who completed their residency 10 years prior with no restrictions.

The result?

According to the published findings, “Exposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30-day mortality, 30-day readmissions, or inpatient spending.” In other words, according to this study, hour restrictions have little-to-no effect on patient outcomes or costs of care.

Doctors Don’t Always Support Fewer Hours

While medical students might appreciate the ACGME’s restrictions, many doctors believe the reduction in hours could negatively impact patient care.

“For many doctors, the 2003 reforms raised concerns that the quality of medical training would be diminished by a shift-work mentality, an erosion of professionalism and an inability of doctors-in-training to witness firsthand the hour-by-hour progression of a critical illness,” writes Anupam B. Jena, MD, PhD, in an article for the Harvard Business Review. “All of which may lead doctors to have less experience on which to base future treatment decisions and insufficiently prepare them for the long hours and patient commitments required in real-life practice.”

In other words, if residents aren’t exposed to as many cases as their predecessors, does that also mean they’re not getting the training and experience they need?

According to the study published by The BMJ, an 80-hour workweek is sufficient, and any hours beyond that limit doesn’t translate into better patient outcomes. In fact, the extra hours may do nothing more than further fatigue doctors and lead them to develop their own health problems over time.

So while long hours will likely always remain a hallmark of the profession, 80-hour-weeks seems an effective limit.

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