Rookie docs can work longer hours safely, study finds
Surgery patients fared just as well when junior doctors worked longer than mandated hours in the first major test of regulations many physicians say hurt medical education.
Nationwide limits on work hours were established more than a decade ago because of concerns that sleep-deprived medical residents were a threat to themselves and their patients.
To test that, researchers randomly assigned more than 4,000 surgery residents to regulation hours or a flexible schedule that allowed them to continue with a case after their shifts ended— sometimes over 28 hours at a time.
The study looked at how many patients died or had serious complications in the month after surgery and found the same low rate— about 9 percent— in both groups.
It’s a landmark study of “a hot-button, controversial issue in health care,” says lead author Dr. Karl Bilimoria, director of surgical outcomes and quality improvement at Northwestern University’s Feinberg School of Medicine. Without flexibility, rookie doctors often have to end their shifts in the middle of caring for patients, handing them off to another resident, possibly at critical times, according to Bilimoria.
“Our hope would be that the evidence would be used . . . to change policies fairly soon and allow flexibility back into surgical residency,” he says.
Residents’ work limits were first set in 2003 by the Accreditation Council for Graduate Medical Education, then revised in 2011. The rules include 80-hour maximum work weeks.
The group said it will consider the results as part of an ongoing review. The council, the Chicago-based American College of Surgeons and the American Board of Surgery paid for the study, which was published by the New England Journal of Medicine and involved almost 139,000 patients treated at 151 hospitals nationwide.
The rules affect medical school graduates involved in residency training programs in hospitals. The rules include shift limits of 16 hours for junior residents and 28 hours for senior residents; eight to 10 hours off between shifts and 14 hours off after a 24-hour shift.