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When one of Aaron's best friends in medical school returned from an interview for a surgical residency program, he told him how some of the surgeons there bragged that they were worked so hard that the divorce rate among their trainees was greater than 100 percent - some of them burned through two marriages.

They were proud of this. Aaron was horrified.

He doubts this statistic was true, even 20 years ago, and he's even surer it's not true now. But it points to an important truth: Some physicians equate "suffering" with "commitment" and believe that a residency should be grueling and difficult.

The limits on how we train residents, and what new studies say about it is the topic of this week's Healthcare Triage.


Those of you who want to read more can go here: http://theincidentaleconomist.com/wordpress/?p=70030

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One of my best friends in medical school returned from an interview for a surgical residency program. He told me how some of the surgeons there bragged that they were worked so hard that the divorce rate among their trainees was greater than 100 percent, ‘cause some of them burned through two marriages.

They were proud of this. I was horrified.

I doubt the statistic was true, even twenty years ago. And I’m even sure it’s not true now. But it points to an important truth: some physicians equate suffering with commitment, and believe that a residency should be grueling and difficult.
The limits on how we train residents and what new studies say about it is the topic of this week’s Healthcare Triage.

[Intro]

A resident is a physician undergoing further on-the-job training after completing medical school. When I was one, I regularly worked 80+ hours a week. When I was in the infant Intensive Care Unit, I was on Q3, meaning that in addition to working 12-hour days, I worked every third night between them as well. In a bad week, I could easily clock more than 90 hours. And I was a pediatrician. Many specialties, like surgery, have it far worse!

Personally, I couldn’t believe that this was good for patient care. Others agreed. In 2003, the Accreditation Council for Graduate Medical Education passed new regulations that capped resident hours at 80 hours per week, and also limited shift lengths and required time off between shifts. In 2011, these were strengthened to limit further the time that interns, or first-year residents, could work.

There are other people in the healthcare industry who believe that such changes are bad for patient care. Reducing hours and shortening shifts mean that doctors have to hand-off patients to one another more regularly. Things could be missed; doctors who are coming on shift might not understand the patients as well as those coming off. Maybe reducing hours is bad for patients.

Most evidence does not support this claim though. A systematic review found that patient health didn’t improve after duty hours were restricted, but few studies found that it worsened.

Beyond patient health, there have been concerns that reduced hours might result in worse education: residents with reduced hours would miss lectures, surgical residents might be forced to leave procedures. These concerns make sense, but most evidence doesn’t support that claim that education is being harmed either.

A recent study published in the New English Journal of Medicine brings us new answers. It was a national study of 117 general surgery residency programs in 2014 and 2015. Programs were randomized to one of two work-hour policies.

The first was traditional – interns couldn’t work more than 16 hours straight, and other residents couldn’t work more than 28 hours straight, 24 for work and 4 for transition. All residents had to have at least 8 (but preferably 10) hours off between shifts, 14 hours if they’d just worked their 28-hour shift. Residents couldn’t work, on average, more than 80 hours a week over four weeks. They had to have 1 full day off every 7 days over 4 weeks, and they couldn’t be on call more than every third night.

The other group was assigned the new flexible policy. In that one interns could work more than 16 hours straight, and residents could work more than the 24/28 hours straight. They weren’t required to have the 8-10 hours off between shifts, or the 14 hours off after a long shift. They still couldn’t work more than 80 hours a week, averaged over four weeks, however. And they still had to have at least one day off for every seven, and still couldn’t be on call more than every third night.

In other words, residents in the flexible policy still had maximum hours capped and days off required, but they could work longer hours per shift to avoid missing procedures or having to hand off patients if they didn’t want to.