Residency has been a right of passage for physicians. Long 36-hour shifts mix with the excitement of new learning. However, recent regulations have now capped residency weekly hours at 80. Although patient medical care in the short-run may improve (because physicians are less tired), in the long run, are physicians exposed to as wide a variety of cases as before? Consider the following sentiment from Chris Sonnenday, a former fourth year resident:
You might expect that, as residents, we’d stand up and rejoice that these regulations have been passed. But I’ll tell you, if you’re the chief resident on the GI service and a case comes up that you may have one or two opportunities during your entire residency to do … well, many of us have to be dragged kicking and screaming out of the hospital.
More important than the doctor’s feelings about residency requirements, how did the hours restrictions affect long-run patient quality of care? This is the question Jena, Schoemaker and Bhattacharya (2014) attempt to answer in their recent Health Affairs paper.
…we studied whether hospital mortality and patients’ length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency.
- Anupam B. Jena, Lena Schoemaker and Jay Bhattacharya. Exposing Physicians To Reduced Residency Work Hours Did Not Adversely Affect Patient Outcomes After Residency. Health Aff October 2014 vol. 33 no. 10 1832-1840. 10.1377/hlthaff.2014.0318