Reducing training hours doesn't lower quality of care after residency

Patient outcomes were not poorer when practicing physicians worked fewer residency hours, a study found. Patients whose practicing, post-residency physicians had been affected by 2003’s reduction in residency hours regulations did not have higher rates of mortality or longer hospital stays, according to a study published in the October issue of Health Affairs.

The 2003 Accreditation Council for Graduate Medical Education (ACGME) regulations imposed a maximum shift length of 30 consecutive hours and an 80-hour work week ceiling on residents in an attempt to reduce fatigue-related errors.

While this has since been further reduced by a 2011 ACGME decision, Anupam B. Jena, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues focused on the effect the 2003 decision may have had on the recently graduated workforce. They determined no ill effects to patients whose practicing physicians had been impacted by the 2003 ACGME regulations.

Using the Florida Agency for Health Care Administration database, Jena et al compared mortality and length of stay for patients of physicians who had completed residencies before, during and after the period affected by the change. The database included physician identifiers that allowed researchers to access physician type and length of time since residency for physicians attached to cases between 2000 and 2009.

The physician types included nonspecialized internists, although results were adjusted for potential hospitalists also in first-year post-residency. Surgeons and specialists were not included because the time lapse was insufficient to gain adequate data on these groups.

They found 8.9 percent of hospitalizations during the research period involved physicians who completed residencies after the 2003 reforms. Internists who had completed residency in 2006 or later were involved with 2.9 percent of hospitalizations reviewed.

When compared directly, mortality appeared lower among patients whose physician had completed residencies after the 2003 reforms. In adjusted analysis, physicians in their first year following residency pre-2003 had a patient mortality rate of 3.29 percent as opposed to 3.19 percent among the post-decision counterparts. Length of stay was similar in patients of physicians who had completed residencies before and after the 2003 reforms.

When treating high-risk patients, physicians who completed residency in 2003 or earlier had a mortality rate of 7.71 percent, as opposed to 7.31 percent among the post-decision set, with no significant difference in length of stay.

However, Jena et al noted that this trend appeared comparable to prior mortality rates. Likewise, trends showed an ongoing decrease in patient mortality in both well-seasoned and first-year post-residency internists, in effect reflecting no change in hospital mortality among patients of first-year internists. 

The research team did note that mortality and length of stay may not be the most nuanced measures.

Jena et al wrote that future analysis should review surgeons; however, the data validated that patients do no worse in the hands of internists who had fewer residency hours.