Duty hour restrictions leave medical interns with little practice time

Duty hour restrictions on first-year general surgery residents have been linked to a 25.8 percent reduction in operating case load, according to a study published yesterday online in JAMA Surgery.

In commentary for the study, Julie Ann Freischlag, M.D., of Johns Hopkins School of Medicine noted that surgical resident duty has been closely monitored since 2003, when an 80-hour work week was instituted. The study aimed to determine whether the 16-hour mandate for postgraduate year one residents, implemented in July 2011, has "adversely affected operative experience."

The study results are a "predictable consequence" of this restriction--2011-2012 interns recorded a 25.8 percent decrease in total operative cases, a 31.8 percent decrease in major cases, and a 46.3 percent decrease in first assistant cases.

The change, obviously, required programs to change their call schedules. Surgical interns at Johns Hopkins now work either 5 p.m. to 5 a.m. or 5 a.m. to 5 p,m. with every Saturday off. The program is trying to maximize the hours interns are in the hospital during scheduled cases. This works for day interns since 90 percent of surgeries performed at the hospital are elective; however, for night interns, it's more of a challenge, Freischlag notes.

The study concludes, "The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume."

Samer Mattar, M.D., of the Indiana University School of Medicine, told Reuters Health that this is just one dilemma medical educators face. "These residents are simply not finding enough time to practice," he said. "You can't go to a pilot and tell them they can't use a flight simulator because it's time to go home."

To learn more:
- check out the Reuters Health article
- read the study abstract and commentary