NCPA - National Center for Policy Analysis


August 21, 2007

Cutting the long hours worked by medical residents was supposed to make patients safer. But in one trauma center that relies heavily on surgical residents, the rate of preventable complications increased after the adoption of work limits, according to an analysis published today.

The limits, which apply to all M.D.s in post-graduate clinical training, cap work hours at 80 hours per week and 30 in a row, and require one day off per week.

Using data from the trauma center at the Los Angeles County and the University of Southern California Medical Center, researchers compared outcomes before and after the limits were introduced:

  • They found that the death rate didn't change significantly.
  • But the rate of "preventable complications" rose after the work limits were introduced.

"This increase in complication rate may be due, in part, to the new 80-hour workweek policy," the authors wrote.  They suggested part of problem may be fragmentation of care as more people are involved in treatment of the same patient.

The limits also seem to be adding to the burdens of faculty surgeons, according to a survey also published today:

  • Significantly more surgeons than non-surgeons reported an increase in work hours, a decrease in job satisfaction, and less time for teaching since the resident work limits were imposed.
  • Surgeons also took a gloomier view of the limits' effects on residents: The surgeons were more likely than non-surgeons to say the limits decreased residents' commitment, and their time spent learning and caring for patients.

Source: Jacob Goldstein, "Work Limits May Spur Surgical Complications," Wall Street Journal, August 20, 2007; based upon: Ali Salim et al., "Impact of the 80-Hour Workweek on Patient Care at a Level I Trauma Center," Archives of Surgery, Vol. 142,  No. 8, August 2007.

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