Working residents to death: Why it doesn’t hurt to treat beginning physicians less like child slave labor

A new study (Bilimoria et al., 2016) was released on February 2, 2016 suggested that allowing surgery residents to work somewhat normal hours at their job — no more than 28 hours at a time — doesn’t result in any worse patient outcomes or complications than working them to death (up to 50 hours at a time, in some cases).

Only in the modern training of physicians do you find work shifts that would put a coal miner from a century ago to shame.

But the folks who did the study claim that this shows that reasonable work hours for physicians in training — residents — are still a bad thing. “They told us very clearly that they thought patient care was better,” one of the researchers claimed.

The work schedule of a second-year resident resembles something from the Industrial Age: duty periods can exceed 28 hours, no required minimum time-off between shifts, 1 day off every 7 days off but averaged over 4 weeks (meaning they could all be bunched up together near the end of the 4 weeks). Children working in a factory in 1899 worked fewer hours and had more time off than residents do in modern medicine programs.

But the new study shows something the researchers probably hadn’t intended — that giving doctors-in-training “reasonable” working hours and time off doesn’t hurt patient care or increase complications. In fact, the study also shows that such improved training standards result in the student doctors’ better mental health:

The most noticeable difference between the two physician groups was the complaint among surgeons working longer shifts that the hours cut into time with their families, friends and activities outside of work. They also said it affected their health, although the study gives no detail on that.

Which, you know, is kind of important given how many physicians take their own lives through suicide nowadays. It’s not coincidental that the rate of depression in residents and medical students is nearly twice the rate of non physicians-in-training (Goebert et al., 2009). Isn’t the health and social well-being of a doctor-in-training just as important as their education? How ironic that medical training programs treat student doctors’ health and psychological well-being as a secondary concern and not worth much attention.

The archaic medical training model, tolerated for more than a century, is appalling and inhumane. It treats residents more like slave labor than students learning a new skill. It continues to be defended by establishment physicians because “that’s the way we always did it. That’s the way we were trained, and we turned out alright.”

This outdated training model is seen as a right of passage in becoming a physician — trial by fire. It’s believed — but rarely verbalized — that if you can’t handle the long hours with minimal sleep (despite the wealth of research showing that disrupted sleep or lack of sleep results in serious health and mental health problems), you’re not cut out to be a physician (or, in the case of this study, a surgeon). As though working the schedule reminiscent of a child working in the factories of 1899 is somehow a positive right of passage role model to replicate.

If doctors want to get serious about fixing their training model, they need to leave the old model of allowing residents to work 30, 40 or even 50 hour shifts behind. The red-herring issues of “handoffs are hard” (harder than going without meaningful sleep for more than 28 hours?!) and patient care continuity can finally be put to rest due to the results of this study.

Doctor training needs to stick to modern training standards of treating other human beings with dignity and respect. There is nothing specific to learning the skills of medicine that requires such a ludicrous suspension of common sense about the health and well-being of people who are trying to learn those skills.

References

Bilimoria et al. (2016). National Cluster-Randomized Trial of Duty Hour Flexibility in Surgical Training. The New England Journal of Medicine.

Goebert et al. (2009). Depressive symptoms in medical students and residents: A multischool study. Academic Medicine, 84.