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Uploaded:2019-07-19
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Performative overwork is more and more common in the United States, and long hours have long been the norm in medicine. During residency, doctors have traditionally been asked to work for up to 100 hours per week. A rule in 2003 capped residents hours at 80 hours per week. Older docs claim this practice skimps on training, and might be worse for patients. A new study indicates that there is no discernable reduction in quality of care across a number of metrics. Maybe the good old days weren't so great.

Related HCT episodes:
1. Doctors and Depression: https://youtu.be/3lda4KyXbLE

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After 12 years of high school, I went to 4 years of college. Then, I went to 4 more years in medical school. Then, 3 years of residency and 2 more years of fellowship, during which I got my master's degree. When my kids are complaining about school, I like to sometimes lob it out there that I pretty much finished the 25th grade. But, there are plenty of physicians who think I had it too easy, and plenty more who think that doc's today aren't getting enough training. New study on that! This is Healthcare Triage News.

[Intro]

After medical school, you spend years as a resident. You're a full-on doctor, but you're still getting more training. You're also not getting paid a ton, and you're working pretty hard. Average salary for a resident? $59,300, and that might sound like a lot, but many residents are working 80 hours a week.

When I was a resident, in addition to working the usual 5 long days a week, I use to spend every fourth night on call, meaning I worked all night watching the patients between work days. On one rotation, it was every third night. I'd pull a 36 hour shift twice a week in addition to working all week days. On that rotation, I'm sure I worked way more than 80 hours per week.

Is that good for patients? Probably not. It's not good for docs, either, as we've covered in previous episodes. Laws have been put in place that prohibit residents working more than 80 hours per week and limited shift lengths to 24 hours. But, many older physicians worry that without those long, grueling hours, docs aren't getting enough training and their patients will suffer.

To the research!

BMJ, brand new study. Association of residency work hour reform with long term quality and costs of care of US physicians: observational study.

This was a retrospective study of Medicare data that used the natural experiment of the 2003 legislation to see how doctors compared before and after hours were capped. Any resident who finished training in 2006 has only ever worked under the cap. Each year before that, docs potentially worked more and more hours in training, to a maximum in 2003 and before. Of course, maybe docs just got better overall in time. So, they also included a control from 10 years prior to all this, when docs also got maximum hours, to account for secular trends.

The main outcomes of interest were 30-day mortality, 30-day re-admissions, and inpatient Medicare spending. The dataset included almost 500,000 admissions.

And? No difference. I'm not going to run through the numbers, because you can go look them up, but there were no statistically significant differences. 

People can argue there might be other metrics that are worse now, but I don't know what they are. And, the metrics we keep measuring show no difference. Data also show that making residents work ridiculously long hours isn't good for them, let alone patients. As someone who often worked more than 80 hours per week, I'll also anecdotally say that my mental health was not good during residency, and the hours could have been a contributor.

Until we see good data proving it's a good idea for people taking care of ill human beings to work 100 hours per week, I'll still think that capping them at 80, which is still somewhat ridiculous, is a step in the right direction.

[Outro]

If you liked this episode, you might also want to watch this other episode on doctors and depression.

We'd especially like to thank our research associate, Joe Sevits, and, of course, our surgeon admiral, Sam. And, like them, you can support the show at Patreon.com/HealthcareTriage.

And, you can support me by buying my book, The Bad Food Bible, out in paperback.