Training Hour Reform Fails to Make Waves

Doctor in surgery

Long training hours have led to fatigue in resident physicians, causing some to make clinical errors that result in patient injuries and death. In hopes of curtailing these errors, the U.S. Accreditation Council for Graduate Medical Education capped the medical resident training at 80 hours per week in 2003. The initial cap prohibited shifts from exceeding 30 consecutive hours, while subsequent reforms further capped shift lengths for interns and other trainees. 

While aiming to be a positive change for students and patients, this reform raised concerns among some physicians. There was speculation that the reduced training hours would produce physicians that were unprepared to be successful in unsupervised independent practice. 

In a study published in BMJ, Ruth L. Newhouse Associate Professor of Health Care Policy Anupam B. Jena, MD, PhD, and colleagues investigated the 30-day mortality rates, 30-day readmission rates, and inpatient Medicare spending of first-year physicians trained before and after the reform. Senior physicians who had been trained before the reform served as the control group.

“Some doctors who trained under the old system are concerned that today’s residents don’t get enough training under the new system,” Jena told HMS News, “It’s not uncommon to hear that today’s residents “aren’t as prepared as we were.’”

Analyzing the treatment of 485,685 Medicare patients, the study revealed that there were no significant changes in patient outcomes after the reform. 

The 30-day mortality rate among patients treated by first-year attending internists saw a decrease of only 1% after the reform was implemented.  Patients treated by senior physicians saw a similar decrease in their 30-day mortality rates, showing no diversion in the preparedness of the new physicians.

After the reform, the 30-day hospital readmission rates for first-year physicians did not change. Senior physicians similarly saw very small changes in their readmission rates. Furthermore, there was no effect on inpatient Medicare Part B spending. First- year internists’ inpatient spending before the reform was only $100 less than it was for physicians trained after the hours cap.

To further examine any possible differences, the study team looked at the treatment of high-risk patients that required specialized care. The patient mortality rate was not affected regardless of the training hours cap.

Overall, a physician’s exposure to work hour reform did not significantly affect their patient outcomes or inpatient spending. The study team stresses the importance of understanding the implications of work hour reforms on the quality and costs of care provided by physicians entering independent practice. They suggest further assessment of the impact of the training hour reforms on other aspects of physician qualities and specialties.