In 2003, legislation limiting the work hours of medical residents to 80-hours-per-week passed in an effort to curb doctor exhaustion and “compromised ability” to care for patients. That ruling, compounded with a 2011 mandate limiting shift length, has led to a debate in the medical community about whether today’s physicians are as well-trained as those of the past. A new study from Harvard Medical School (HMS) may settle that debate.
“If you’re working 90 to 100 hours per week, you’re spending all of your time treating patients, you know the patients well, you know how the diseases progress, you’ll have seen more conditions, and so when you enter into independent practices, you’ll have a larger body of experience on which to draw,” says Anupam Jena, an HMS professor and the study’s lead author, when summarizing the argument of reduction opponents. “The concern of many physicians is resident physicians aren’t as well-trained as they used to be.”
Jena’s research, however, suggests that may not be the case. His study examined nearly four million hospitalizations in Florida from 2000 to 2009, and cross-referenced the data about patient outcomes against data about whether their attending physicians completed their residencies prior to the 2003 hour reduction. The study still found that there had been little to no change in patient length of stay and mortality rates, although it did not look the length of time it took doctors to make diagnoses.
Considering that result, Jena—who completed his own medical residency from 2009 to 2012, after the weekly hour reduction—says he feels duty hour debates should not focus on physician expertise, but rather ensuring that residents are well-rested enough to effectively treat patients. “Once you’re in the hospital for 80 hours, it’s hard to imagine that that extra 10 hours is going to contribute so much to your learning and experience as a physician that it’s going to matter in your independent practice,” he says. “I think the real [issue] to consider is, what’s the well-being of the resident?”
Dr. Richard Pieters, president of the Massachusetts Medical Society, echoes Jena’s view, at least as far as resident well-being is concerned. “Sleep deprivation is good for no one,” he says, adding that he hasn’t noticed any anecdotal decrease in doctor quality. “It was a good change, and frankly, at the time, I didn’t think about impact on learning curves. I think it varies from specialty to specialty.”
Along that vein, Pieters says more studies like this are needed to keep pace with the rapidly changing medical field. “I think, as the authors suggest, it leaves a lot to be discovered,” he says. “It’s really indeterminate as to how far the reduction in hours will impact on the quality of physicians. The world of medicine is constantly changing, evolving, and progressing, and physicians remain engaged in that constant learning process that we hope will improve quality of care and outcomes of patients.”
Source URL: https://www.bostonmagazine.com/health/2014/10/16/medical-residency-hours-debate-doctors/
Copyright ©2021 Boston Magazine unless otherwise noted.