Medical residents like limited shifts, but program directors prefer more flexibility

Female nurse looking stressed
A study found medical residents are happier when their shifts are limited. (Getty/gpointstudio)

A new study found that limiting shift hours for medical residents improved their satisfaction without affecting educational outcomes.

But while residents liked having limits on how many hours they could work per shift, residency program directors were dissatisfied with the limits compared to programs that allow for more flexible hours, according to the study published in The New England Journal of Medicine.

But when it comes to the quality of medical education, the shorter shifts did not affect how well residents did on tests of medical knowledge or how much time they spent with patients, researchers from the Johns Hopkins School of Medicine and the Perelman School of Medicine at the University of Pennsylvania found.

The study reported only on educational outcomes, not on some of the more controversial questions that arise in the debate over the long hours residents work: whether they impact patient mortality and affect interns’ sleep and alertness.

"Many educators have worried that the shift work created by limited duty hours will undermine the training and socialization of young physicians," the study's principal author David Asch, M.D., a professor of medicine at the University of Pennsylvania, said in an announcement. "Educating young physicians is critically important to healthcare, but it isn't the only thing that matters. We didn't find important differences in education outcomes, but we still await results about the sleep interns receive and the safety of patients under their care." Researchers plan to publish a further study with those results.

In this part of the study, researchers compared internal medicine programs in the U.S. that operated under the Accreditation Council for Graduate Medical Education policies, which limited resident workweeks to 80 hours and shifts to 30 hours, to others regulated by more flexible policies that did not specify any limits on shift length or mandatory time off between shifts.

The number of hours residents work has been controversial. In a reversal of policy, the ACGME began allowing first-year doctors to work 24-hour shifts in hospitals starting July 1. That revoked a 2011 decision to limit shifts for first-year residents to 16 consecutive hours.

Opponents said the change would jeopardize patient safety by putting new, sleep-deprived doctors in charge of patients, but the ACGME said returning first-year residents to the same schedule as other residents and fellows will allow for better team-based care and seamless continuity of care with fewer handoffs of patients between doctors.