The American Association of Medical Colleges estimates that there will be a shortage of physicians in the U.S. over the next decade. Projections show a shortage ranging between 61,700 and 94,700 in the US physician workforce, with a significant shortage among many surgical specialties. This obviously means that the already long workday will get longer for residents who are currently expected to work up to 80 hours a week. As a medical transcription company, we are well aware that physicians need to have a work-life balance and play our part in reducing their workload with accurate and timely medical documentation. However, recent reports indicate that a “normal life” eludes young doctors.
How many hours can resident physicians can work on a given day? This is still a widely debated topic in modern medicine. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited that the resident physician could work no more than 80 hours a week averaged over the course of a month. The aim was to limited medical errors by overworked residents. In 2011, these rules were revised and the consecutive hours that interns could work was limited to 16 hours. As of July 1, 2017, the ACGME changed the 16 hour shift rule and interns can now work shifts of up to 28 hours.
Lack of proper sleep is one main reason for physician stress and burnout. A study published in the British Columbia Medical Journal in 2005 noted that several reliable studies of physicians have shown that sleep deprivation has several negative impacts:
- Impairs language and math skills
- Impairs ECG interpretation
- Results in poorer quality intubations
- Increases time taken to perform laparoscopy and error rates in performance
- Increases error rates in an intensive care unit
- Increases motor vehicle accidents
- Can produce less empathy for patients and poor communication
- Causes significant family and marital stress
Electronic health records (EHRs) have made things even more difficult by turning physicians into data entry operators.
A physician-authored blog published in The Huffington Post in 2012 summarized the serious consequences of sleep deprivation among doctors. One study found that surgical complications increased when attending surgeons had less than a six-hour window for sleep between their final evening procedure and their first procedure the following day. Another study found that Interns who worked five or more extended-duration shifts a month reported 300 percent more preventable errors associated with fatigue that resulted in fatalities. It was found that, when sleep deprived, 22 percent of residents in this study were more likely to commit medical errors.
How do residents use their precious off-duty time? A 2015 AMA article discusses a study that identified two key behaviors among residents grappling with maintaining work-life balance and deciding how to make the best use of their personal time. The study which took place from 2012 to 2014 at a Canadian medical school accredited by the Liaison Committee on Medical Education, sought to understand the following matters:
- residents’ nonclinical post-call activities when they leave the hospital
- their decision-making processes, and
- their views on the relationship between these activities and their well-being or recovery
The study authors reported that residents try to balance competing priorities and use “two trade-off orientations” that is, being oriented toward maintaining a normal life or toward mitigating fatigue, when making decisions about how to use their post-call days. They changed their priorities according to the situation and previous experience.
Trade-off One: Residents wanted to maintain “a normal life” post-call restricted sleep to a few hours or sacrificed rest altogether to pursue the following activities:
- Connecting with family and friends
- Completing important life errands such as going to the bank, a dentist appointment and getting their car repaired
- Completing duties such as working out and buying groceries to increase their sense of personal fulfillment and productivity
Trade-off Two: Other residents prioritized catching up on sleep post-call to mitigate fatigue and recover from overnight shift. Key trends observed among these residents included:
- Substantial differences in sleep durations – some wanted to sleep ‘for as long as possible’ while others deliberately restricted their daytime sleep with the intention of preserving their sleep-wake cycle
- The need to explain to their colleagues about why they preferred to sleep
- Concerns about missing important opportunities such as “sacrificing valuable educational experiences by leaving the hospital and choosing to sleep or rest”
These studies hold great relevance in a time when physician burnout is an ongoing problem. According to the 2016 Survey of America’s Physicians commissioned by the Physicians Foundation, nearly half (49 percent) of 17,000 physicians surveyed reported feeling burnt out some or all of the time. Physician burnout has negative effects on patient care, professionalism, physicians’ own care and safety, and the reliability of health-care systems. The need of the hour is to implement strategies to reduce practice work load. While medical transcription outsourcing can reduce the clerical work burden, building mindfulness and implementing a team-based model within the practice can help decrease physician burnout to a great extent.