Medical Resident Work Hours - Effects On Health

Effects On Health

A study of over 8 million hospital admissions of Medicare beneficiaries published in 2007 comparing mortality rate before and after implementation of the ACGME standards showed no difference in mortality. However, it is largely felt that actual duty hours (opposed to reported duty hours) have not changed substantially, and this explains this result. Prior to a change in work hours, residents were working, on average 82 hours per week.. The study relies on self reported hours. A significant bias to under report hours worked exists for two important reasons. One is that statutes do not provide whistleblower protections to residents who report work hour violations. Second, the penalty for work hour violation is loss of accreditation, which would adversely affect the medical resident since he would not be able to become board certified in his/her field of medicine. Furthermore, an accompanying study done in the Veterans Administration setting (with 318,636 patients) by the same researchers showed that work hours restrictions reduced mortality substantially for a similar set of diagnoses. Another study found that the 2003 ACGME reforms restrictions were associated with a small reduction in the relative risk for death in 1,268,738 non-surgical patients drawn from a national survey of hospitals.

Research from Europe and the United States on nonstandard work hours and sleep deprivation found that late-hour workers are subject to higher risks of gastrointestinal disorders, cardiovascular disease, breast cancer, miscarriage, preterm birth, and low birth weight of their newborns. Chronic sleep deprivation and the resulting fatigue and stress can affect job productivity and the incidence of workplace accidents. There are also social effects. Married fathers in the United States who work fixed night shifts are 6 times more likely than their counterparts who work days to face divorce; for married mothers, fixed nights increase the odds by a factor of 3.

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