February 25, 2011

Many New Doctors Still Working Too Long

A new survey, published in the Archives of Surgery, finds that 6 out of 10 surgical residents work more hours than safety regulations allow.

The results found that more than a third of 144 new doctors did not take long enough breaks between their shifts. And one in five worked more than 90 hours per week.

Doctors who are completing their training -- known as residents -- should limit their workload to 80 hours per week or less, take a 10-hour break between shifts, and take a day off once a week, according to rules designed to ensure patient safety.

"It's a big challenge to comply with these duty hour regulations," Dr. Celia Divino, the lead researcher on the study and the chief of general surgery at Mount Sinai Medical Center in New York City, told Reuters Health.

The Accreditation Council for Graduate Medical Education (ACGME) is the force behind the structuring of residents' work hours rules. Since 2003 residents across all disciplines have had to comply with these rules.

Divino said patient safety and doctor fatigue were the main drivers for implementing and enforcing the rules. Patient safety is more likely to be compromised when doctors are sleep deprived or exhausted. They do not learn well either, she added.

The survey showed, however, that it is not all that easy to get away from the hospital and take a break. Being involved in emergency cases is one of the most common causes for doctors and residents working over the allowable hours.

"You can't, in the middle of an operation, say, OK, I have to go," said Divino.

Divino's research also found that sub-specialties, including trauma and vascular surgery, were more prone to working overtime, likely because these include the sickest patients.

Many doctors find it difficult to hand off care. The answer to this problem is so-called physician extenders, such as physician assistants and nurse practitioners, who can cover patient care while a doctor is taking down time.

Many programs that train residents have had to make staffing changes and bring in monitoring systems since the rules were applied. At Mount Sinai, for example, the computer system will block a resident from putting in a patient order if she has exceeded her work hours, Divino said.

Divino said that since the survey was conducted, in 2007 and 2008, there have likely been some improvements in compliance with the rules, and she believes they have had a positive impact on patient safety and resident education.

ACGME plans to enforce tighter rules for residents' work schedules later this year. However, studies have not agreed upon whether the current regulations actually improve patient safety.


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