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How a Return to 24-Hour Shifts Benefits Patients and Doctors


Beginning July 1, doctors who recently graduated from medical school are going back to being allowed to, and in some cases being required to, work 24-hour shifts.  There had been a rule in place for the last five years limiting their shifts to 16 hours.  

The change only affects doctors who are in their first year of training, the year immediately following the graduation from medical school.  Those who have completed more than one year of training have always been allowed to work 24-hour shifts, a policy that still stands.  

The training following graduation from medical school is called residency. The number of years a doctor spends in residency depends on the type of medicine the doctor is pursuing. 

The 16-hour shift cap was instituted out of concern for patient safety as well as the new doctors' well-being.  A number of doctors and medical students had expressed concern that exhausted doctors pose a danger to themselves and others. 

However, it turned out the patients and doctors benefited more from the 24-hour shift.  

For one thing, many doctors didn't want to go home after 16 hours.  

Dr. Anai Kothari, a third-year surgical resident at Loyola University Medical Center who served on the task force examining the shift cap, told The New York Times he had had a 16-hour maximum shift when he was a first-year resident, and much preferred the 24-hour maximum for residents in subsequent years.

"Most people want to be there for the patient if the patient needs them," he said. No one, Dr. Kothari added, wants to leave in the middle of an operation.

Dr. Stephen Evans, past chairman of the American Board of Surgery and chief medical officer for MedStar Health, a hospital system in the Washington area, also favored giving first-year residents the option to work a longer shift.

"If you are a pediatric first-year resident taking care of a critically ill patient, and the child dies, do you just walk away from the family because the 16 hours are up?" he asked.

Furthermore, a study of first-year surgical residents, published last year in the New England Journal of Medicine, found that shorter shifts had no effect on patient care. In fact, proponents of the long shift argued the hand-off from one doctor to another at shift change was more problematic than one doctor sticking with the patient for the long haul, because the continuity of care bolstered patient outcomes, particularly if the same doctor follows a patient in the critical hours following admission.

Allowing first-year residents to remain on duty for 24 hour shifts does not always mean requiring them to do so, although in some cases it does.  In many cases it gives doctors the option to stay or leave.  Many doctors who choose to stay are motivated by a desire to become more proficient as physicians.

The 24-hour shifts do not mean the doctors are awake and working the entire shift.  Many hospitals have designated sleeping quarters for doctors in training to grab some shut-eye during their shift. 

The new rules leave in place a requirement that all residents, first year and beyond, work no more than 80 hours a week.

Research shows after completing residency, most physicians work an average of 65 to 70 hours a week, throughout their careers.

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