The work-hour restriction debate: Better rested docs vs. continuity of care

Young doctors may be better rested thanks to work-hour restrictions, but patients don't seem to benefit at all. Some residents say that the shorter shifts hurt continuity of care because they must go home when their time is up and hand off patient care to another clinician.

The rules are most problematic for surgeons, according to a recent article published by Slate, because they must hand off patients in the middle of an operation or other urgent situations.

"The surgical community in particular is concerned about this and feels duty hour restrictions have impaired continuity of care," Karl Bilimoria, M.D., a professor at Northwestern University's Feinberg School of Medicine, told the publication.

But the recent move to increase resident work hours has its critics. Two consumer advocacy groups recently asked the federal government to stop a pilot program experimenting with 30-hour work shifts. They argue that the grueling shifts pose serious health risks to student doctors and patients.

"Substantial evidence shows that sleep deprivation due to excessively long work shifts increases the risk of motor vehicle accidents, needle-stick injuries and exposure to blood-borne pathogens and depression in medical residents," Public Citizen said in a statement. "It also exposes their patients to an increased risk of medical errors, sometimes leading to patient injuries and deaths."

But recent research finds that the work-hour limits don't improve patient safety at all. It only increases the number of patient hand-offs--a frequent cause of adverse events. And, Slate noted, other research shows that the interns who worked under the work-hour limitations experienced depression just as their counterparts did prior to the restrictions and also didn't report a greater sense of well-being.

Even worse, Slate reported, many young doctors in the study also reported they didn't necessarily get better rest because of the shorter shifts. On average they got 12 minutes extra shut eye per night.

To learn more:
- read the article