Last year we wrote a blog post on the benefits and drawbacks of work-hour restrictions for surgeons. Although the restrictions helped lessen doctor burnout and led to a higher quality of life for residents, some believed it left doctors less prepared to deal with the rigors of daily medical life. New research published by Reuters confirmed that fear in a recent study, which found that doctors who followed work-hour restrictions preformed worse on their certification tests and saw a drop in patient safety.
As noted in the previous story, the work-hour restrictions forbid residents from working more than 16 hours in a row or more than 80 hours in a week. Researchers uncovered that while capping weekly hours a 80 per week was beneficial, limiting residents to 16-hour shifts appeared to be detrimental to both resident and patient well-being.
“The study reinforces something that most surgeons already know or at least feel – strict duty-hours regulations don’t have the beneficial effects that many people hoped they’d have, and they may have a detrimental effect,” Dr. Brian Drolet said in an interview Reuters Health.
Work-Hour Study
For their study, researchers analyzed previous surveys and polled residents and program directors about the state of their medical care center both before and after the work-hour restrictions went into effect. The results can be seen below.
- After analyzing a collection of surveys sent to 14 different medical centers, 11 revealed that residents had a strong impression that patient satisfaction had suffered after the work-hour restrictions were imposed.
- When analyzing another set of 15 surveys, 12 found that residents and program directors believed training and education had deteriorated after the restrictions were put in place, while the other three noticed no change.
- Surgical boards have reported that oral exam failure rates have risen over the last decade.
- The number of candidates who have failed their thoracic surgery test has tripled over the past decade, while the failure rate for general surgery has nearly doubled.
Dr. Najma Ahmed, lead author of the study, said a universal approach to work-hour restrictions is detrimental to surgical residents.
“One size does not fit all for training,” said Ahmed. “Training in dermatology or psychiatry would be different than training in neurosurgery,” she said.
Future studies are set to dive deeper into the issue, and Ahmed hopes regulators will heed the evidence, instead of listening to outside influences.
“My fear is that some of these changes are political in nature and not based in evidence.”
Dr. Silverman comments
In the previous post I played devil’s advocate for both arguments, but ultimately I decided that I believed a more knowledgeable doctor was better than a better-rested surgeon.
A resident can only get that hands on experience from long shifts and hours spent observing, and cutting into that training will inevitably leave them less prepared. Working those long hours is tough and it tests your mental and physical strength, but I can guarantee you’ll be a better surgeon for it.
I will follow the new studies closely as I concur with Dr. Ahmed’s belief that we should listen to the evidence, not the politics, when it comes to resident and patient care.
Related source: Rueters