The physician shortage has put greater demands on the physician community, leading to more work hours and greater patient workloads. 
High workloads and fatigued physicians can lead to poor patient care and costly medical mistakes. A study published in The Journal of the American Medical Association found that “physicians who have burnout are more likely to report making recent medical errors, score lower on instruments measuring empathy, and plan to retire early and have higher job dissatisfaction, which has been associated with reduced patient satisfaction with medical care and patient adherence to treatment plans.” Medical residents are subject to the same risks, as they frequently work marathon shifts and get very little time off. The Accreditation Council for Graduate Medical Education (ACGME) allows residents to work 28 hours in a row every other shift, and caps weekly hours at 80. Add the fact that these fatigued residents are inexperienced and the potential for errors gets even higher. The Wall Street Journal recently published an article where two medical professionals debated the pros and cons of limiting the number of hours medical residents can work. Steven W. Lockley, Ph.D., a neuroscientist in the Division of Sleep, Brigham and Women’s Hospital (BWH), Boston, and an associate professor at Harvard Medical School argued for limiting hours. Here are his reasons why:
High workloads and fatigued physicians can lead to poor patient care and costly medical mistakes. A study published in The Journal of the American Medical Association found that “physicians who have burnout are more likely to report making recent medical errors, score lower on instruments measuring empathy, and plan to retire early and have higher job dissatisfaction, which has been associated with reduced patient satisfaction with medical care and patient adherence to treatment plans.” Medical residents are subject to the same risks, as they frequently work marathon shifts and get very little time off. The Accreditation Council for Graduate Medical Education (ACGME) allows residents to work 28 hours in a row every other shift, and caps weekly hours at 80. Add the fact that these fatigued residents are inexperienced and the potential for errors gets even higher. The Wall Street Journal recently published an article where two medical professionals debated the pros and cons of limiting the number of hours medical residents can work. Steven W. Lockley, Ph.D., a neuroscientist in the Division of Sleep, Brigham and Women’s Hospital (BWH), Boston, and an associate professor at Harvard Medical School argued for limiting hours. Here are his reasons why:
- A study conducted by BWH showed that medical residents who worked 24- to 30-hour shifts every other shift made 36% more serious medical errors than those who worked a schedule with 16-hour shifts.
- Residents working 24 or more hours in a row reported sticking themselves with needles 60% more often.
- In a 2010 review of 23 studies on the effects of reducing resident work hours, all but one showed an improvement or no change in patient care or resident sleep or quality of life.
- There were no objective data showing that shorter work hours were worse for patients or physicians.
Jane Orient, MD, executive director of the Association of American Physicians & Surgeons, argued against limiting resident training hours for the following reasons.
- More work hours means more opportunities to learn for medical residents.
- Future patients may be at risk of receiving treatment from a less-experienced doctor.
- Shorter shifts lead to more-frequent handoffs, disrupting education and patient care.
- Part of physician training is learning how to cope when exhausted.
Both sides seem to have compelling arguments. What do you think?
