Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted? Two recent studies in the Journal of the American Medical Association suggest that the answer is no. In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented. Their test scores did not improve either. In the other, hospitalized Medicare patients being cared for by physicians working shorter hours experienced no improvement in mortality or readmission rates.
US resident duty hour restrictions were born in 2003, when the ACGME, the organization that accredits medical residency programs, capped the work week at 80 hours. It also mandated that residents have 10 hours off between duty periods and a 24 hour limit on continuous duty, with 1 day in 7 free from patient care. In 2011, the organization revised its policy, further restricting the total number of continuous duty hours for physicians in the first year of training to 16.
How could well-intentioned attempts to ensure that hardworking young physicians get sufficient rest fail to benefit patients? To begin with, simply restricting duty hours does not guarantee that residents will use their extra off-duty time to sleep. They might, for example, use it to study, exercise, or socialize. It is also possible that the outcomes being assessed by these studies are influenced by so many factors that merely changing duty hours is insufficient to cause a change. Yet if such changes do not benefit patients, how strong is the case for their implementation?
Some educators worry that duty hours restrictions are undermining the quality of medical education. For example, a survey of surgery program directors published last year showed that 21% believe that residency graduates are unprepared for the operating room, 30% believe they cannot independently remove a gallbladder, and 68% believe they cannot perform a major procedure unsupervised for more than 30 minutes. Another survey showed that 38% of residents themselves lack confidence in their preparation even after 5 years of training.