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sagittariisXII t1_j8xm7q6 wrote

Reply to comment by mlippay in Penn Medicine residents and fellows want a union, citing grueling workloads and 80-hour workweeks by nankles

Time to change the norm

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ferrusmannusbannus t1_j8xrfvt wrote

They tried it. They did huge studies on it. It ended in way worse patient care and more deaths. Handoffs are the biggest risk to a patient and unfortunately these long shifts resulted in better care

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k0mm13 t1_j8xwf01 wrote

If you're referring to the iCOMPARE study, that is patently false. There were no differences in mortality, readmission or other patient safety indicators. Interns reported more dissatisfaction with flexible hour programs (i.e., not long shifts) while program directors felt the opposite. https://www.nejm.org/doi/full/10.1056/nejmoa1810642 https://www.nejm.org/doi/full/10.1056/NEJMoa1800965

There was similarly no difference in patient outcomes for surgical residents. https://www.nejm.org/doi/full/10.1056/NEJMoa1515724

Additionally, it is not the long shifts that are the problem. Almost everyone who does this job knows what they're signing up for at this point since your last 2 years of medical school is spent spending thousands of hours around residents. What people I've talked to have a problem with is being undervalued and abused by the healthcare systems on top of these expectations.

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all_akimbo t1_j8xv5gl wrote

Citation?

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OptimusSublime t1_j8xvz98 wrote

u/ferrusmannusbannus imagination, 2023, Reddit.com

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ferrusmannusbannus t1_j8xy9ep wrote

New England Journal of Medicine

https://www.nejm.org/doi/full/10.1056/NEJMoa1900669

Northwestern University

https://news.northwestern.edu/stories/2016/02/longer-shifts-surgical-residents-safe

Jama Study on Handover Mortality

https://jamanetwork.com/journals/jama/fullarticle/2589342

Canadian Medical Association

https://www.sciencedaily.com/releases/2015/02/150209122838.htm

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ForkBombGoBoom t1_j8ybps9 wrote

> New England Journal of Medicine > https://www.nejm.org/doi/full/10.1056/NEJMoa1900669

This study says: "Longer Shifts for Surgical Residents are Safe for Patients"

It does not say: "[Making residents work less hours for more money] ended in way worse patient care and more deaths. "

> Northwestern University > https://news.northwestern.edu/stories/2016/02/longer-shifts-surgical-residents-safe

This study says: "resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts, although the effect varied by site." However, it adds a big caveat: "The number of ICU patients cared for by each resident physician was higher during schedules that eliminated extended shifts." Additionally, the shorter shifts could still be 16 hours, and there was no data about total hours worked in a week, just about the length of a single shift.

It does not say: "[Making residents work less hours per week or for more money] ended in way worse patient care and more deaths. "

> Jama Study on Handover Mortality > https://jamanetwork.com/journals/jama/fullarticle/2589342

This study says: "End-of-rotation transitions may introduce risk in internal medicine inpatient care."

It does not say: "[Making residents work less hours per week or for more money] ended in way worse patient care and more deaths. "

> Canadian Medical Association > https://www.sciencedaily.com/releases/2015/02/150209122838.htm

This study says: "Shorter duty hours for medical residents, although marginally better for residents themselves, may result in worse patient care, according to a randomized trial assessing resident duty hour schedules in the intensive care unit."

This is the closest to your argument, but again, it looks at the length of individual shifts, not total hours worked in a week or month, which may have more of an impact.

Until we see a few studies showing that sustained 40 hour workweeks with 8 hour work days are inferior in patient outcome, I think these are all just bullshit.

And even then, the issue is wellbeing of the residents. It's not all about the patients. My workplace does better if I work 100 hours a week; I do not.

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ferrusmannusbannus t1_j8ydk3a wrote

40 hour work weeks will never work for residencies unless you are going to double the length of them which no one wants. You have an absolutely insane amount to learn.

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