By Matt Kuhrt
New regulations governing the number of hours doctors can work during residency have sparked an argument as to whether longer shifts are harmful to residents or patients.
But the debate hasn't addressed the bigger question, according to Aaron E. Carroll, M.D., professor of pediatrics at Indiana University School of Medicine, in a piece for The New York Times. Arguments about the best way to train doctors end up failing to ask whether those longer or shorter shifts affect the training and skill levels of the doctors working them, he said.
It has long been a given that a residency involves grueling hours and intense workloads, in large part because they represent on-the-job training for medical professionals. Regulations established in 2003 and tightened in 2011 limited the duration of shifts, but a recent study from the New England Journal of Medicine indicated the decrease in hours had no significant improvement on patient outcomes.
In addition, a backlash has developed against the restriction in resident hours, predominantly on the basis of reduced continuity of care. Shorter-duration shifts lead to more patient handoffs, which themselves have been cited as a cause of adverse events, as FiercePracticeManagement previously reported. For all the arguments pro and con, however, there's no hard evidence that shorter work hours hurt patient outcomes, according to Carroll, who also cites anecdotal evidence suggesting residents' training has not suffered either.
However, there is evidence that the stress of residency programs leads to depression and other mental health issues in a significant percentage of future physicians. In the absence of hard evidence otherwise, Carroll said, it may be worth an otherwise neutral change in policy "to be sure that as we create doctors, we aren't sacrificing human beings."
To learn more:
- read the Times piece