When the reforms shortened the working hours of American doctors in training, some worried: was the time enough to learn the art of medicine? Would future patients suffer?
From now on, a study provides answers and found no difference in terms of death, readmissions or hospital costs when comparing the results obtained with trained physicians before and after the limitation of the number hours of work, limiting tasks to 80 hours a week.
"Some stay long for 100-hour work weeks, but most of the world has evolved and realized that there were better ways to train residents," said Dr. Karl. Bilimoria, Feinberg School of Medicine, Northwestern University. involved in research published Thursday in the journal BMJ.
By eliminating extra paperwork and some academic conferences for residents, while adding nurse practitioners to the job market, training is more effective, Bilimoria said.
Previous studies have suggested that reforms have not harmed residents' patients. The new study is the first to offer reassuring results similar to the doctors once they have found themselves in the real world, said Dr. Mitesh Patel of the University of Pennsylvania, not involved in the study. ;study.
Dr. Isaiah Cochran, 26, worked 75 hours a week, including 16-hour shifts, at the Children's Dayton Hospital in Ohio for a final part of her last year's work. School of Medicine. He plans to apply for residency in family medicine next year.
"It's feasible – it's not crazy," said Cochran, president of the American Association of Medical Students, which supports the maintenance of the 80-hour ceiling and others. measures to guarantee doctors adequate sleep.
For this study, researchers analyzed data from more than 400,000 hospitalizations of Medicare patients. Using billing codes, they assigned each case to a key physician who cared for each patient the most.
The researchers then compared the cases of two six-year periods: before and after 2006, when the first new physicians fully affected by the reforms had completed their residency.
It was an era of improving patient safety. The researchers compared the new physicians – some affected by the reforms and others not – to the trends observed among veteran physicians with 10 years of experience and all trained under the old rules.
They found no difference in deaths, readmissions, or patient costs.
Patients depend on hospital teams and not just one doctor, which may explain why the time spent on training does not seem to affect care.
Teamwork and technology have so changed hospital care that the impact of a physician is reduced, said senior author, Dr. Anupam Jena of the school of Harvard Medicine.
And more artificial intelligence is coming. With computers playing a bigger role in diagnosis and treatment, Jena said, "It should remain an open question if 80 hours a week is the right number" for training. Maybe it could be less.
Results apply to internal medicine physicians, not surgeons. Additional research is needed to find out if surgeons are getting enough experience during training, Jena said.
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