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Limiting New Doctors' Shifts Isn't Seen As Cure

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The Associated Press

Published: September 5, 2007

PHILADELPHIA - Cutting the grueling work hours of doctors-in-training had little effect on reducing patient deaths, according to two large studies.

Death rates dropped in one group of patients in veterans hospitals but not in three other groups, the researchers reported.

The results come from what the authors describe as the largest and most comprehensive national look at work-hour restrictions, which were implemented four years ago to try to reduce medical errors by tired physicians.

'We were a little surprised,' said Kevin Volpp, the studies' lead author and a physician at the Philadelphia Veterans Affairs Medical Center. 'We thought that mortality outcomes would improve more consistently.'

The studies appear in the latest edition of the Journal of the American Medical Association.

The new work-hour rules limit doctors-in-training to 80-hour weeks. Critics of the restrictions feared they would hurt continuity of care for patients and create a shift-work mentality among doctors. Others supported the limits, saying they might lead to fewer deaths from medical mistakes.

Before the rules, medical residents often worked 100-hour weeks, with some shifts lasting 36 hours. Although the new limits are still about double what other full-time jobs require, long hours for doctors-in-training are seen as a traditional trial-by-fire approach that give them necessary, intensive experience.

The two studies included 318,000 VA patients and more than 8.5 million Medicare patients at hospitals nationwide. The researchers looked at deaths within 30 days of hospital admission in the years before and after the rules went into effect in 2003. They compared death rates between hospitals with a large number of residents and hospitals with few residents.

One study examined VA patients treated for a heart attack, stroke, gastrointestinal bleeding or congestive heart failure. It found that two years after the rules were implemented, mortality improved by 11 percent to 14 percent in major teaching hospitals, compared with hospitals with few residents. There was no change in mortality rates for VA surgical patients.

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