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Massachusetts health care — wonky, with a healthy dose of reality

Hour Limits on Interns May Have Unintended Consequences

Hour Limits on Interns May Have Unintended Consequences

April 26, 2013

No one wants an exhausted doctor making decisions about their health. That’s why the Accreditation Council for Graduate Medical Education, which is charged with accrediting American medical residency programs, has continued to take steps to limit the time doctors in training spend on the clock. The most recent restrictions, established in 2011, target interns, limiting their work day to no more than 16 hours. It’s a common sense solution to a justified anxiety about fatigued doctors.

Yet the measure may not have been as effective as predicted. A New York Times article surveys emerging literature relating to these changes, and the results may cast doubt on the ultimate effects of hour restrictions. Since the changes, interns have not been getting more sleep, nor are they happier. Evidence suggests the regulations may even be stunting the educational progress of these doctors: interns have actually been spending less time in educational activities, as the time needed for these conferences and lectures contributes to the 16 hour limit on their time.

Patients haven’t been receiving better care, either – no significant improvements in patient care have been reported since the hour limits. One study reveals an increased concern among interns about making medical errors after the change.

The problem with the regulations? Demand for care stays steady, no matter how many hours doctors work, and hospitals haven’t matched this demand by hiring more interns. This means that interns find themselves spread thinner and thinner, as they struggle to complete all their responsibilities with less time to do them. “It’s as if you told airline pilots that they could only work a certain number of hours, but they had to fly 50 percent more flights,” said Dr. Lara Goitein, lead author of a recently published editorial in JAMA Internal Medicine.

Physician fatigue is a very real problem, but efforts to address it should not stop at blanket-level restrictions. Instead, hospitals need to devote money to hiring more doctors in order to ensure that each patient can receive quality care from an engaged and focused professional. There’s no denying that such an effort would result in short-term losses, but the payoffs in better patient care – and, perhaps, outcomes – would likely be well worth it.
-Devon Branin