Consistent Direction Despite Wavering Policy: Reductions in Resident Physician Extended Duration Shifts Over 20 Years - 01/03/25
Doi : 10.1016/j.amjmed.2025.01.001
Matthew D. Weaver, PhD a, b, ⁎ 
, Laura K. Barger, PhD a, b, Jason P. Sullivan, BS a, Salim Qadri, BS a, Charles A. Czeisler, PhD, MD a, b, #, Christopher P. Landrigan, MD, MPH a, b, c, d, #
, Laura K. Barger, PhD a, b, Jason P. Sullivan, BS a, Salim Qadri, BS a, Charles A. Czeisler, PhD, MD a, b, #, Christopher P. Landrigan, MD, MPH a, b, c, d, # a Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
b Division of Sleep Medicine, Harvard Medical School, Boston, MA
c Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
d Department of Pediatrics, Harvard Medical School, Boston, MA
⁎Requests for reprints should be addressed to Matthew D. Weaver, PhD, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Division of Sleep Medicine, Harvard Medical School, 221 Longwood Ave, Suite 438A, Boston, MA 02215.Division of Sleep and Circadian DisordersBrigham and Women's HospitalDivision of Sleep MedicineHarvard Medical School221 Longwood Ave, Suite 438ABostonMA02215
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Abstract |
We examined data from 17,498 physicians-in-training who reported on 92,662 months of work over a 20-year study interval that included three major revisions to work hour limits. Extended duration shifts (≥24 hours; EDS) are much less common than they used to be. On average, first-year resident physicians (PGY1s) currently work a total of 4 EDS per year and 3 EDS per month during months in which any EDS are worked. This is in stark contrast to the experience of PGY1s training in the early 2000s when the average was approximately 1 EDS per week over the year. More senior resident physicians (PGY2+) have observed concurrent reductions despite their exclusion from the ACGME guidelines limiting EDS. Resident physicians across all levels of training in surgical programs continue to work more EDS than those in medical programs. Similarly, resident physicians on intensive care unit rotations work these shifts more frequently compared to other rotations.
Le texte complet de cet article est disponible en PDF.Keywords : Duty hours, Resident physicians, Work hour policies
Plan
| Funding: This work was supported by the National Institute for Occupational Safety and Health (NIOSH) R01OH011773, R01OH07567, and R01OH010300. |
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| Role of the Funder/Sponsor: NIOSH had no role in the design or conduct of the study; and no role in the collection, management, analysis, or interpretation of the data. NIOSH had no role in the preparation, review, or approval of the manuscript; and was not involved in the decision to submit the manuscript for publication. |
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| Conflict of Interest: Dr. Weaver reports institutional support from the National Institutes of Occupational Safety and Health, National Institutes of Health, Delta Airlines, and Oura; and consulting fees from the Fred Hutchinson Cancer Center and the University of Pittsburgh. Dr. Barger reports institutional support from the National Institutes of Occupational Safety and Health and Delta Airlines. Dr. Czeisler reports grants and contracts to Brigham and Women's Hospital from Axsome Therapeutics, CDC Foundation, Dayzz Live Well, Delta Airlines, Jazz Pharmaceuticals PLC Inc, Puget Sound Pilots, Regeneron Pharmaceuticals/Sanofi during the conduct of the study; reports personal fees from Axsome Therapeutics, Associated Professional Sleep Societies, Bryte Foundation, Clement Law Firm, Institute of Digital Media and Child Development, Klarman Family Foundation, Law Offices of James L Mitchell, Law Office of Yolanda Huang, Massachusetts Medical Society, National Council for Mental Wellbeing, National Sleep Foundation, Puget Sound Pilots, Rabb and Rabb LLC, Segal Law Firm, Shaked Law Firm, P.A., Simpson & Simpson, Tencent Holdings Ltd, Teva Pharma Australia, The Armstrong Firm, PLLC, Vanda Pharmaceuticals Inc, With Deep, Inc. and Zehl Law Firm, during the conduct of the study; reports research/education support to Brigham and Women's Hospital from Abbaszadeh Foundation, Alexandra Drane, Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, Casey Feldman Foundation, Cephalon, DR Capital, Eisai Co., LTD, F.lux Software, LLC, Idorsia Pharmaceuticals LTD, Mary Ann & Stanley Snider via Combined Jewish Philanthropies, Harmony Biosciences LLC, Jazz Pharmaceuticals PLC, Inc, Johnson & Johnson, NeuroCare, Inc., Optum, Peter Brown and Margaret Hamburg, Philips Respironics Inc, Regional Home Care, ResMed Foundation, San Francisco Bar Pilots, Sleep Number Corp., Stuart F. and Diana L. Quan Charitable Fund, Summus, Inc., Takeda Pharmaceutical Co., LTD, Teva Pharmaceuticals Industries Ltd, ResMed, Sanofi, Philips, Vanda Pharmaceuticals and Whoop, Inc. during the conduct of the study; and is the incumbent of an endowed professorship provided to Harvard University by Cephalon Inc. during the conduct of the study; report serving as an expert witness in legal cases, including those involving Advanced Power Technologies, Aegis Chemical Solutions LLC, Amtrak, Bombardier, Inc., Casper Sleep Inc, C&J Energy Services, Delta Airlines/Comair, Enterprise Rent-A-Car, FedEx, Greyhound Lines, Inc., Harmony Biosciences LLC, Puget Sound Pilots, Steel Warehouse, Product & Logistics Services LLC, San Francisco Sheriff's Department, Schlumberger Technology Corp., Union Pacific Railroad, UPS, and Vanda Pharmaceuticals during the conduct of the study; reports having an equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc. during the conduct of the study; and reports receiving royalties from McGraw Hill, Massachusetts Medical Society, and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices during the conduct of the study. Dr. Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Landrigan has consulted with and holds equity in the I-PASS Institute, which seeks to train institutions in best handoff practices and aid in their implementation. In addition, Dr. Landrigan has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety, and has served as an expert witness in cases regarding patient safety and sleep deprivation. |
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| Authorship: MDW: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Visualization, Writing—original draft, LKB: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing—review and editing, JPS: Data curation, Investigation, Methodology, Project administration, Writing—review and editing, SQ: Data curation, Investigation, Methodology, Project administration, Writing—review and editing, CAC: Conceptualization, Data curation, Investigation, Methodology, Supervision, Visualization, Writing—review and editing, Funding acquisition, CPL: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Supervision, Writing—review and editing. |
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