Closure on the Duty Hours Debate?

Published in Aequanimitas - Aequanimitas Spring 2019

My hope is this will be my last column on duty hours. This tense debate has persisted for decades. In March, we published the final primary outcomes data from our study on this topic in the New England Journal of Medicine, which I hope will move us beyond studying specific shift lengths.

As a reminder, the debate focuses on the conflict between the sciences of chronobiology and operations. Our iCOMPARE study randomized 63 programs across the country to the 2011 limits of 16 hours for interns versus no shift-length restriction. Importantly, programs in both arms had to have 80-hour-per-week limits, one day off in seven, and call no more frequently than every third night. The new findings relate to patient safety and sleep.

As we wrote in a recent op-ed, we found that patients cared for by doctors with longer shifts did no worse than those cared for by doctors with shorter shifts. That’s reassuring.

Many draw parallels to the strict hours of a pilot. And though the freshly rested pilot swapped in after a few hours doesn’t need to know anything about the passengers in each seat, the swapped-in doctor needs to know a lot about the patients in each bed. Shorter shifts means more patient handoffs, and that means more errors. Besides, regulating how long doctors work doesn’t mean you're regulating how long they sleep. Our outcomes from education last year showed that burnout is a real problem—no matter how many hours a resident worked.  

In the end, I hope we focus less on how many hours they are here and more on what they're doing while they are here.

Sanjay Desai, Director

Osler Medical Training Program