Capping Work Hours in Residency Does Not Impact Outcomes Later

Exposure of U.S. physicians to work-hour reforms during residency training is not associated with post-training differences in patient mortality, readmissions, or costs of care, according to a study published online in The BMJ.

Anupam B. Jena, M.D., Ph.D., from Harvard Medical School in Boston, and colleagues compared 30-day mortality, 30-day readmission, and inpatient Medicare Part B spending for patients treated by first-year internists fully exposed to 2003 work-hour reforms during their residency (completed residency after 2006) and for those treated by first-year internists with partial or no exposure to reforms (completed residency before 2006).

The researchers did not observe any significant associations between exposure of physicians to work-hour reforms during residency and differences in outcomes. For patients of first-year internists, 30-day mortality rates during 2000 to 2006 and 2007 to 2012 were 10.6 and 9.6 percent, respectively; rates were 11.2 and 10.6 percent for those treated by 10th-year internists not exposed to reforms during their residency. Thirty-day readmission rates were 20.4 and 20.4 percent during 2000 to 2006 and 2007 to 2012, respectively, for first-year internists and 20.1 and 20.5 percent, respectively, for 10th-year internists. Medicare Part B inpatient spending was $1,161 and $1,267 per hospital admission, respectively, for first-year internists; for 10th-year internists, spending was $1,331 and $1,599, respectively.

"Further assessment of the impact of both the 2003 and the 2011 residency work hour reforms on other aspects of physician quality and in other specialties is important," the authors write.

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