Reduced work hours for trainee doctors not seen to compromise care

(Reuters Health) – Physicians who trained in U.S. hospitals under recent reforms that capped their work hours appear to provide care that’s similar in cost and quality to doctors who trained before workday reforms took effect, a new study suggests.

Reforms passed in 2003 by the Accreditation Council for Graduate Medical Education (ACGME) established a maximum 80-hour work week and capped shifts at 30 hours for doctors in training known as residents. While the intent was to prevent mistakes by exhausted residents, some in the medical community worried that fewer hours would leave these trainees unprepared to practice on their own.

For the current study, researchers examined data on 485,685 patients covered by Medicare who were admitted to U.S. hospitals and treated by a general internist – a doctor finished with training – between 2000 and 2012. They looked at patient outcomes and costs for first-year internists trained before and after the 2003 work reforms took effect as well as for internists with 10 years’ experience, who acted as a control group.

There was no meaningful difference in patient deaths, repeat hospitalizations or costs between doctors who trained with reduced hours and any of those who completed training before the reforms took effect, researchers report in The BMJ.

“One concern with restricted work hours is that residents may not be as adequately trained for independent practice as they used to be when work hours were unrestricted,” said Dr. Anupam Jena, lead author of the study and an internist at Massachusetts General Hospital in Boston.

“Our study suggests that any additional time spent training beyond 80 hours a week doesn’t seem to deliver benefit in terms of improving patient outcomes or reducing costs,” Jena said by email. “It may also be the case that because hospital care is multi-disciplinary, including specialist physicians, nurses, and other health care providers, any slight relative deficiency in a given physician’s experience may not be important for patient outcomes.”

The patients of first-year internists who trained when hours were unrestricted had 30-day mortality rates of 10.6%, compared with 9.6% for first-year internists who trained no more than 80 hours a week. Patients of internists with 10 years of experience, who all trained with unrestricted hours, had 30-day mortality rates of 11.2%.

Researchers also looked at how many patients had repeat hospitalizations, or readmissions, within 30 days of discharge. No matter when their doctors trained, the patients of first-year internists had readmission rates of 20.4%. The more experienced internists’ patients had readmission rates of 20.1% to 20.5%.

Medicare spending per patient admission was $1,161 for first-year internists who trained with unrestricted hours and $1,267 for their counterparts who trained later. For the more experienced internists, Medicare spending per patient admission was $1331 before the reforms and $1,599 after reforms took effect.

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 specialists. Shift lengths also changed under reforms implemented after 2003 and the study doesn’t examine the impact of these additional changes.

Still, the findings should reassure patients that their care won’t necessarily be compromised because doctors trained only 80 hours a week, said Dr. Christopher Moriates, assistant dean for healthcare value at the Dell Medical School at the University of Texas at Austin.

“This evidence adds to what those of us in medical education have seen – our residents continue to work really hard and are committed to learning their craft, so while they may work fewer hours, it appears their outcomes are likely the same,” Moriates, who wasn’t involved in the study, said by email.

The 80-hour work week is also likely here to stay, said Dr. Krisda Chaiyachati, a researcher at the University of Pennsylvania in Philadelphia who wasn’t involved in the study.

“I think it feels humane to keep work hours to no more than 80 hours,” Chaiyachati said by email. “I imagine it would be politically challenging to ask young physicians to routinely work, say, 100 hours a week.”

SOURCE: bit.ly/2YOWjjN The BMJ, online July 10, 2019.