Shorter rotations prevent physician exhaustion but hurt teaching

Amid debates over fewer work hours for physicians, a new Journal of the American Medical Association study found that shorter rotations for attendings doesn't negatively affect patients, in terms of unplanned revisits, and could stave off physician burnout.

The study, published online last week, looked at two types of schedules for inpatient attending physicians at a teaching hospital, one with a two-week rotation and one with a four-week rotation. Researchers from Cook County Health and Hospitals System and Rush Medical College in Chicago, Ill., found that either schedule didn't significantly affect patient outcomes in revisits (emergency room or urgent ambulatory care clinic revisits, admissions to the same hospital or transfers from another hospital).

Both schedules resulted in about a 21 percent rate for unplanned revisits and an average of 67 hours in length of stay.

The study suggested the two- versus four-week rotation was up to personal preference. Attendings liked the shorter schedules, but their trainees didn't.

For instance, 16 percent of attending physicians with the shorter rotation reported burnout--half of the 35 percent of doctors who reported burnout on the longer rotations. And 19 percent of doctors on the two-week schedule reported emotional exhaustion, compared to 37 percent on the four-week schedule.

So while the shorter rotations didn't directly hurt patient care, it also didn't necessarily help. Trainees assigned to those attendings said the shorter rotations hurt the student-teacher relationship, MedPage Today reported.

Still, study authors noted the long-term effects of exhaustion also can affect patients.

For more information:
- see the JAMA study abstract
- here's the MedPage Today article

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