Study Suggests Surgical Residents Can Safely Work Longer Shifts : Shots - Health News Researchers tested whether loosening restrictions on the work schedules of doctors in training would lead to more harm to patients.

Study Suggests Surgical Residents Can Safely Work Longer Shifts

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AUDIE CORNISH, HOST:

Here in the U.S., doctors in training work a lot of hours but probably not as many as they would have just over a decade ago. In 2003, limits were placed on the number of hours medical residents can work, and more restrictions were added in 2011. Now some surgeons are pushing back, saying the rules are overly strict. And this week, a study published in the New England Journal of Medicine offers data to support their cause. Now, here to talk about this study with us is Jordan Rau. He's senior correspondent at Kaiser Health News. Welcome to the studio.

JORDAN RAU: Thanks for having me.

CORNISH: OK, Jordan, so tell us a little bit more about this debate, which, I gather, has a lot to do with this idea of sleep deprivation and the potential for medical errors.

RAU: Residents used to work about 110 hours or even more a week. I mean, they practically lived at the hospital. And the concern became that if they were working that much and they weren't getting sleep, they were going to make a lot of unforced errors and mistakes and it was hurting patients. So new rules were put in place and strengthened over time, and those rules limited the amount of time that they could work to 80 hours a week on average. And within that, the residents could only work about 28 hours straight, and then they had to take a break.

But surgeons became concerned about it for a couple of reasons. One is, the surgeons who oversaw those residents - it's - was harder to organize, harder to manage the care. There was also concern about the educational part, which was that the residents wouldn't be able to follow a patient from the time that they were admitted through if they were having surgery the next day and just really see and learn the whole course of care. And then the third concern was called the handoff, which is if the doctor or resident had to leave because their shift was over and was a firm stop, the resident would have to just stop caring for that patient, give it to another resident or doctor who was not familiar with the case up to them and that that might be dangerous for patients.

CORNISH: OK. So along comes this New England Journal of Medicine study, and what are these findings saying?

RAU: Well, the study looked at 117 surgical residency programs, and it was an experiment. Half of those residency programs kept on doing the things that they were doing with these limits in place. And the other half were freed from most of the limits. And after a year, they took a look at what the results were on the patients, and they found that between the two groups, there was no substantial difference in patient deaths or patient serious complications so that the group that had loosened the rules and were presumably working longer were not causing any excessive harm to the patients.

CORNISH: So how does this change the debate or bring people to any kind of consensus about whether residents should be allowed to work longer hours?

RAU: Well, this gives more statistical fuel to the argument that maybe the rules aren't necessary to protect patients. But there's some skepticism about the pushback because residents are cheap labor and getting them to work longer is more convenient for the surgeons and cheaper for the hospital. And there's still some concerns about the underlying issue, which is that if you're sleep-deprived, you're going to make mistakes. And maybe they're not to the extent of killing the patient, but they can still be substantial or important mistakes.

CORNISH: Is this about more than sleep?

RAU: It's not just sleep. I mean, for the one thing, there's an element of pride in the medical culture that doctors can pull these crazy long hours and that they are able to do that and retain their facilities. And in some types of surgery, it's really important to be able to do that because they're very, very long.

But beyond that, it's part of a broader shift, which is that doctors used to have full autonomy and full control over their lives. And there's a move towards making them, you know, more shift workers that are employed by hospitals and they work at set hours. Doctors are now being measured on the quality of their care by insurers and other people. They're not used to be second- guessed. And so there's some concern that you don't want to treat doctors as if they were just, you know, industrial line workers. But on the other hand, the reality of health care is that it's becoming more of a team effort, and it's not just sort of the sole practitioner overseeing all aspects.

CORNISH: That's Jordan Rau. He's senior correspondent with Kaiser Health News. Thanks so much for coming in.

RAU: Thank you.

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