According to The Toronto Star
, the push for change began back in 2007, when a member of the Quebec union for medical residents (Fédération des médecins résidents du Québec, FMRQ) filed a complaint that his Charter rights to "life, liberty and security of the person" were being violated by the 24-hour shifts. In 2011, an arbitrator ruled in favour of the resident, and gave Quebec one year to make accommodations for the shorter shift times. As of July 1, 2012, medical residents in Quebec starting working their 16-hour shifts.
If all goes well in Quebec, hospitals across Canada may be incorporating similar changes. Health Canada is aiming to create a Canadian consensus on how many hours residents should be working. The changes have been endorsed by the Canadian Medical Association
and the Canadian Association of Interns and Residents
. The move will echo trends in other countries towards reducing residents' working hours. The medical 'rite of passage' of excessive working hours is slowly becoming a thing of the past.
The shortened shifts mean that residents may be less likely to be suffering from fatigue when you walk into the emergency department. Patients may feel more at ease being seen by a front-line doctor who they feel is not overworked.
So far there have been no problems with the new shorter hours. Dr. Charles Dussault, president of the FMRQ, says that patient care "is for sure doing better."
However, there is a risk. Normally, when a resident works a complete 24-hour shift, he or she is more likely to see a patient from arrival at the ER through to discharge. This is less likely to happen with the shorter shifts. Critics of shorter shifts are concerned that vital patient information might not be passed adequately from one resident to another at the end of a shift. A study of 16-hour shifts at The Mayo Clinic
found that residents felt less prepared for handing off patients when their shifts finished.
Indeed, this writer has personally experienced the importance of avoiding a patient information hand-off between medical residents, during two long ER stays with my daughter this year. In the first instance, the ER resident made sure to stay until she was completely treated and discharged from the hospital. He wrote out instructions for us and made all follow-up referrals before he left. He bounded out of the ER, backpack in tow and with a big wave for my daughter, at the same time we did. In the second instance, the ER resident stayed until the end of his shift. He had done most of the work and quite a few procedures, but he just wanted our daughter to stick around another half hour to monitor something. About three hours later, we still had not seen the replacement resident, and we had to remind the hospital we were still around. The new resident suddenly appeared and did not seem aware of what she was supposed to be monitoring. If shortening the shifts could result in more patient information communication errors like this or potentially much worse, it can't be a good thing.
Still, a sleepy physician is a sleepy physician.
"The reality is we can engineer . . . better ways to make sure information doesn’t get dropped, whereas we’re never going to be able to engineer a human that doesn’t need to sleep in a 24- hour period,” said Dr. Christoper McCoy, lead investigator of the study and instructor of internal medicine at The Mayo Clinic.
Update: A new study published in the journal Pediatrics has found that reducing medical residents' shift hours will result in the need for additional staff such as non-resident physicians and nurse practitioners.
Time will tell how the medical residents in Quebec fare with their shorter shifts and whether the new policy will be adopted nationwide.