FAQ Friday: Do Longer Hours for Surgical Residents Endanger Patients?

by Emily Geitner on Mar 25, 2016 8:30:00 AM

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A new study led by Northwestern Medicine showed that allowing surgical residents the flexibility to work longer hours in order to stay with patients until the end of an operation or stabilize them during a critical event did not pose a greater risk to patients.

The highly-anticipated study: The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial was published in the New England Journal of Medicine and presented at the Academic Surgical Congress on Feb. 2, 2016.

“It’s counterintuitive to think it’s better for doctors to work longer hours,” said principal investigator Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “But when doctors have to hand off their patients to other doctors at dangerous, inopportune times, that creates vulnerability to the loss of critical information, a break in the doctor-patient relationship and unsafe care.”

The study also found surgical residents reported no worsening in their overall well-being and personal safety when working longer hours. In fact, these surgical residents noted considerable improvements in patient safety and the quality of their training.

SURGICAL RESIDENTS STUDY: METHOD

Researchers divided about 120 surgical programs into roughly two equal groups. Altogether, about 4,330 general surgical residents treated almost 139,000 patients during the 2014-15 academic year.

The control group of surgical residents were subject to the restrictions on residents put in place in 2003 and 2011 by the Accreditation Council for Graduate Medical Education, which includes:

  • 16-hour shift limits for first-year surgeons
  • 28-hour shift limits for second-year surgeons
  • A maximum 80-hour work week, averaged over four weeks
  • At least eight hours off between shifts, and at least 14 hours off after a 24-hour shift

Surgical residents in the second group also had an 80-hour work week limit, but no shift limits and required time off between shifts.

PREVIOUS STUDIES AND PROTESTS

Some previous studies had come to similar conclusions, but this one has been anticipated because of its more rigorous methods. The trial has drawn protests from Public Citizen and the American Medical Student Association, which said researchers put patients and residents at risk by waiving the rules.

The groups assert that the experiment, funded by the American Board of Surgery, the American College of Surgeons and the accreditation council, was never likely to find a significant difference in patient outcomes, since most elements of patient care—the physicians, specialists, nurses and other clinical workers — remained unchanged.

"Research on the deleterious effects of chronic sleep deprivation is just overwhelming," said Dr. Deborah Hall, president of the medical student association. "I'm concerned we're going to walk away from a lot of progress that's been made without overwhelming data [showing] that residents aren't subject to the ordinary limits of human neurobiology."

Not everyone agrees with Dr. Hall. In an editorial published in the New England Journal of Medicine, John D. Birkmeyer, M.D. states:

“I reach a different conclusion. The FIRST Trial effectively debunks concerns that patients will suffer as a result of increased handoffs and breaks in the continuity of care. Rather than backtrack on the ACGME duty-hour rules, surgical leaders should focus on developing safe, resilient health systems that do not depend on overworked resident physicians. They should also recognize the changing expectations of postmillennial learners. To many current residents and medical students, 80-hour (or even 72-hour) workweeks and 24-hour shifts probably seem long enough. Although few surgical residents would ever acknowledge this publicly, I’m sure that many love to hear, ‘We can take care of this case without you. Go home, see your family, and come in fresh tomorrow.’”

If you're a resident or other medical professional (and this sounds all too familiar), feel free to leave a comment on your perspective of these longer hours – we’d love to hear your thoughts or personal experiences. If you would like information about how to reduce your medical student loan payments, call us today at (844) 226-LINK (5465). We’re here and happy to help.

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This post was written by Emily Geitner

Emily is Director of Operations & Marketing for LinkCapital and responsible for managing the company’s day-to-day operations as well as leading strategy, marketing, and user experience for all Link consumer products.