Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries

Breuer, Rina Maoz; Waitzberg, Ruth; Breuer, Adin; Cram, Peter; Bryndová, Lucie; Williams, Gemma; Kasekamp, Kaija; Keskimäki, Ilmo; Tynkkynen, Liina-Kaisa; Ginneken, Verena van; Kovács, Eszter; Burke, Sara E.; McGlacken-Byrne, Domhnall; Norton, Carol; Whiston, Barbara; Behmane, Daiga; Grike, Ieva; Batenburg, Ronald; Albreh, Tit; Pribakovic, Rade; Bernal‐Delgado, Enrique; Estupiñan-Romero, Francisco; Angulo-Pueyo, E; Rose, Adam J.

doi:10.1016/j.healthpol.2023.104753

Cited by 9 publications

(2 citation statements)

References 59 publications

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“…The regulation of work hours for residents has been predominantly enforced in the U.S., Europe, and Canada, with other nations, particularly in Asia, more recently adopting similar measures (Table 1). 8,10,11 However, Japan is scheduled to impose such regulations in April 2024. Most countries' regulations on resident work hours consist of two components: the total number of working hours (e.g., hours worked per week) and the longest continuous working hours in a shift.…”

Section: Work-hour Reg Ul Ationsmentioning

confidence: 99%

The effects of resident work hours on well‐being, performance, and education: A review from a Japanese perspective

Nagasaki,

Kobayashi

2023

J of Gen and Family Med

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This article examines the impact of working‐hour restrictions on the well‐being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80‐hour‐per‐week regulation in the United States and the 48‐h‐per‐week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working‐hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working‐hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.

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Section: Work-hour Reg Ul Ationsmentioning

confidence: 99%

The effects of resident work hours on well‐being, performance, and education: A review from a Japanese perspective

Nagasaki,

Kobayashi

2023

J of Gen and Family Med

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“…Efforts to shorten work hours are also taking place in other countries [ 11 , 12 ]. While the mechanism and roadmap for reducing work hours remain a matter of debate, there is a growing consensus on its necessity.…”

Section: Reduction Of Overnight Shift Durationmentioning

confidence: 99%

Healthcare policy changes in an era of health workforce shortage

Angel

Fire

2023

Isr J Health Policy Res

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In their recent IJHPR article, Wimpfheimer and colleagues outline the implications for the field of anesthesia of two major healthcare policy changes in Israel: The Yatziv Reform in licensing foreign medical graduates and the efforts to reduce residents' on-call shift duration. We argue that these reforms are necessary to strengthen the healthcare workforce and improve the quality of care in the long term, even though they may limit the availability of healthcare personnel for several years, particularly in the field of anesthesia. In this commentary, we examine the background to these policy changes, their likely impact on the medical workforce in Israel in general, and propose steps to reconcile these reforms with the global and national shortage of physicians. We urge policymakers to allocate the required resources and begin preparing for an era of continuous mismatch between physician supply and demand, which will necessitate creative solutions, increased reliance on technology, and the introduction of paramedical professionals to help offload tasks and better utilize the scarce physician workforce.

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Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule

Massar,

Chua,

Leong

et al. 2024

JAMA Netw Open

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ImportanceExtended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues.ObjectiveTo compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule).Design, Setting, and ParticipantsIn this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024.ExposureParticipants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs.Main Outcomes and MeasuresSleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties).ResultsParticipants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P &lt; .001; PSQI mean [SD] score, 6.5 [2.3]; t79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (−13%; β = −6.79; 95% CI, −9.32 to −4.27; P &lt; .001), motivation (−21%; β = −10.09; 95% CI, −12.55 to −7.63; P &lt; .001), and sleepiness ratings (29%; β = 15.96; 95% CI, 13.01 to 18.90; P &lt; .001) and impaired vigilance (21 ms slower; β = 20.68; 95% CI, 15.89 to 25.47; P &lt; .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; β = −15.72; 95% CI, −28.27 to −3.17; P = .01) than nights without naps.Conclusions and relevanceIn this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.

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Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries

Cited by 9 publications

References 59 publications

The effects of resident work hours on well‐being, performance, and education: A review from a Japanese perspective

The effects of resident work hours on well‐being, performance, and education: A review from a Japanese perspective

Healthcare policy changes in an era of health workforce shortage

Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule

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