Dr. Ken’s Corner: Are Patients Harmed When Residents Work Fewer Hours?

When work hours for residents in training were capped at 80 hours per week, two questions came up:

  1. Will residents have enough time to learn everything they need to know?
  2. Will the residents’ future patients suffer as a consequence?

A recent study appears to have answered these questions.

The study’s investigators faced persistent “speculation that physicians completing residency today have less robust clinical experience before entering unsupervised practice compared with pre-reform residency cohorts” (per July 2019 BMJ research.) They assumed, however, that “it might also be possible that residents who are less fatigued consolidate their knowledge better and have equivalent or greater clinical competency both during and after residency.”

Led by Harvard’s Dr. Anupam Jena, the objective was to find out if doctors who trained before 2003, when the work week was typically 100 hours, had better patient outcomes than doctors who trained after the new rules were enacted in 2003: In addition to reducing work hours to no more than 80 per week, the new rules required that no individual shift could be longer than 30 hours.

Dr. Jena and his team studied 485,685 hospitalized patients in over 4000 U.S. hospitals between 2000 and 2012. They looked at data for just the sickest patients, a “group of patients for whom the experience and training of a doctor is really important,” said Dr. Jena in a STAT news article. When they compared general internists who trained before and after reforms were put into place, they found no significant differences in hospital mortality, readmissions, or inpatient spending. In other words, reducing residents’ work hours did not have a negative impact on the overall quality of patient care. “If anything, it’s reassuring,” said Dr. Sanjay Desai, director of Johns Hopkins’s internal medicine residency program.

“One limitation of the study is that it only looked at general internists, and it’s possible results would look different for surgeons or other specialties,” said Dr. Christopher Moriartes of the University of Texas Dell Medical School (in an article for Reuters). Dr. Moriartes said “the findings should reassure patients that their care won’t necessarily be compromised because doctors trained only 80 hours a week.” It should also be noted that the impact of any one doctor in today’s hospital environment is muted because of a greater focus on teamwork and technology. “And more change is ahead with artificial intelligence,” said Dr. Jena for the Associated Press.

It  would be “politically challenging” to ask young physicians to return to routinely working 100 hours a week, said Dr. Krisda Chayachati, a researcher at the University of Pennsylvania in Philadelphia (from the same Reuter’s article mentioned earlier). “The 80-hour work week is…likely here to stay.”

Ken Teufel, M.D.