Restrictions On Medical Residents' Hours Show Improvements; Doubts Remain

Main Category: Medical Students / Training
Also Included In: Primary Care / General Practice
Article Date: 09 Aug 2007 - 2:00 PDT

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Restrictions established in 2003 on the number of hours that medical residents may work have been found to decrease exhaustion, but some evidence still shows that extended hours put doctors and patients at risk, the Boston Globe reports (Mello, Boston Globe, 8/6). In July 2003, the Accreditation Council for Graduate Medical Education limited residents' work schedules to no more than 80 hours per week (Kaiser Daily Health Policy Report, 12/12/06). The regulations also cap at 30 the number of continuous hours a resident can work and require residents to rest for 10 hours between shifts.

To accommodate for the rules, some hospitals have hired more residents, rearranged schedules and transferred some duties to more experienced physicians. A study published in the July 17 issue of the Annals of Internal Medicine, conducted by Stanford University researchers showed a small but significant drop in mortality rates for medical patients at teaching hospitals compared with nonteaching facilities during the first year the rule took effect. The study showed no impact on surgery patients.

A companion study conducted at Yale-New Haven Hospital showed a link between the new rules and decreases in medication errors, drops the number of patients requiring intensive care and an increase in patients being ready to return directly home after their hospital stays. However, "spotty implementation" makes it difficult to gauge how effective the regulations are, the Globe reports. Hasan Bazari, director of the internal medicine residency program at Massachusetts General Hospital, said the regulations have "transformed residency from an obstacle course to something that's actually sustainable and enriching. But at the end of the day we still have the question of what is the right mix of experiences and exposures to train a doctor."

A survey published in the July 23 Archives of Internal Medicine showed that 73% of hospital faculty members said the regulations have left fewer chances for residents to experience bedside teaching, while 57% said there is less opportunity to perform clinical procedures. Specialists' "frustration" with the rules "stems in part from the fact that cash-strapped hospitals have failed to make fundamental changes on their already overburdened wards," according to the Globe. Leora Horwitz, lead author of the Yale study, said, "It's a foolish thing to respond to work hour limitations by saying to residents, please do the same amount of work in less time," Horwitz said, adding, "But that's how most programs have responded." In addition, sleep researchers maintain that 30-hour shifts still are too long to significantly affect patient safety (Boston Globe, 8/6).

The Annals of Internal Medicine study is available online. An abstract of the Archives of Internal Medicine study is available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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