Time magazine recently published an article highlighting the controversy surrounding work hour restrictions placed upon doctors in training. Work hour restrictions were initially enacted by the state of New York in 1987 in response to the death of an 18 year old female, caused by a medication prescribing error made by a resident in the middle of a 30 hour work shift. As a result of the 18 year old’s death, New York limited the hours a resident could work to a maximum of 80 hours a week, down from the 100+ hour work week norm and 36 hour call shift. Following suit in 2003, the Accreditation Council for Medical Education further limited shifts to 24 hours straight. The enactment of the 2003 regulations was met with controversy and mixed results. Even so, a study published in 2004 found that reducing medical residents’ work hours during rotations in the intensive care unit resulted in a significant reduction in medical errors.
According to the Agency for Healthcare Research and Reform, long and unpredictable work hours have been a staple in medical training for centuries. The term “resident” is a throwback to the days of when a physician in training actually lived at the hospital. Many viewed the grueling schedules as a necessary rite of passage.
In 2011, work hour restrictions underwent another revision. Currently, first year residents are not allowed to work more than 16 hours straight. Second year residents and above can work 24 hours straight with four additional hours allowed for continuity of care – provided there are no new clinical responsibilities assigned after 24 hours of continuous in-house duty.
According to new data published by JAMA Internal Medicine, the new work hour limitations may actually cause more medical errors to occur. In particular, in a study that involved 2,300 doctors, researchers compared a population of first year interns operating pre 2011 hour restrictions with interns operating under the post 2011 limitations. The data was surprising – the percentage of interns reporting a patient error actually went up under the new restrictions. The findings were preliminary with the increased error rate based upon the self-reporting of residents.
The study’s authors hypothesized that this increased error rate could be attributed to the fact that interns were still expected to accomplish the same amount of work in less time, leading to work compression and increased on the job pressure. In addition, work hour restrictions can lead to a lack of continuity of care for patients. In the end, the Time Magazine article acknowledges that striking a balance with manageable work hours while achieving an optimal learning environment that provides for high quality patient care may still be a work in progress.