A call for meaningful work hours for residents

By Chris Worsham, MD

March 8, 2016

The decade-long debate surrounding the resident physician work hour regulations put into place in 2003 and 2011 is coming to a boil. With one large study of surgical residents completed (the FIRST Trial), and one of medical residents nearing completion (the iCOMPARE Trial), the duty-hours conversation has elicited opinions from senior and junior physicians from across the country.

The debate has focused largely on the hours. How many hours worked is too many before we start putting patients at risk for errors or residents at risk for physical and mental health problems? How many hours are too few that we start sacrificing education or putting patients at risk for errors related to decreased continuity of care and increased patient handoffs?

Clearly residents need some minimum amount of experience to be adequately trained for independent practice; after all, the purpose of residency in the various specialties is to give freshly-minted doctors this experience under supervision.

But, as we wrote in an opinion published several weeks ago, we think the debate has missed a major point: what residents actually do during these hours is important too. Working 24 hours straight—if spent providing direct patient care—can be a very valuable contribution to the rigorous training America expects of its doctors. But if a resident working a 12-hour shift spends half of it doing paperwork, filling out forms, making appointments, or faxing records, he or she is not getting a full 12 hours of educational clinical experience.

As this author points out, duty hour regulations play important roles outside of the hospital as well and can affect different members of our workforce in different ways. When work hours are limited, residents can better handle their responsibilities outside the hospital or clinic. After all, we need time to run errands, eat well, exercise, pursue hobbies in addition to starting and raising families. The FIRST trial, for example, found that while surgical residents working more “flexible” hours seemed to be unaffected at work, they were more likely to report negative effects on their personal lives.

It’s hard to imagine a single set of duty hour regulations that would be ideal for every resident in every training program in every specialty across the country, and we should not assume that time spent away from work does not add value to our training and our workforce. But as the debate roars on, we believe it is of particular importance to focus on what a “work hour” actually is, and we implore hospitals and their house staff to collaborate to make sure these hours are meaningful through initiatives that reduce waste and improve efficiency.

Dr. Worsham is a senior resident in internal medicine at Boston Medical Center.