Capping Trainees’ Work Hours Does Not Harm Patient Care

Limiting the number of hours that doctors in training work to 80 hours per week had no adverse effects on patient care, according to a study published in BMJ.

To determine the effects of residency work hour reforms introduced by the Accreditation Council for Graduate Medical Education in 2003, researchers analyzed data from more than 400,000 hospitalizations of Medicare patients from two six-year time periods, 2000 to 2006 and 2007 to 2012, when the first new doctors who were fully affected by the reforms had finished their residencies. The authors then linked doctors to patient cases using billing codes based on which doctor interacted with each patient. This analysis revealed that there were no differences in 30-day mortality, 30-day readmissions, or inpatient costs between doctors trained before and after the limits took effect.

One reason that doctor training may not seem to affect care is that patients rely on hospital teams, not a single doctor. Another is that technology has augmented hospital care so much that the impact of any single doctor is diminished.

Technology could have an even more outsized impact in hospital care as artificial intelligence is integrated into patient care, the study researchers noted. More and more computers are playing a larger role in diagnosis and treatment, raising the question of “whether 80 hours a week is the right number” to properly train a physician, according to lead author Anupam Jena, MD, of Harvard Medical School.

Reducing training hours for residents may upend the traditional training model, but some physicians are beginning to warm up to the idea.

“Some still long for the old days of 100-hour work weeks, but most of the world has moved on and realized there are better ways to train residents,” said Karl Bilimoria, MD, of Northwestern University Feinberg School of Medicine, who was not involved in the research study.

Source: Associated Press, July 11, 2019; BMJ, July 10, 2019.