Israeli medical residents who have finished medical school and internship and seek to learn a specialty have for many years been compelled to work long hours to pack in advanced learning under the tutelage of senior physicians and to fill in especially during night and weekend shifts.
This has led to demonstrations and protests by residents – who get married after service in the Israel Defense Forces and then go to medical school and are thus older than their counterparts in other Western countries. Their home life suffers, and – dead tired – their lack of sleep can cause mistakes.
As a result of the endless shifts, many Israeli hospitals have required residents to work up to 26 hours up to eight times per month – during a day shift from 8 a.m. to 4 p.m. and to continue for an additional 18 hours from 4 p.m. until 10 a.m. the next day. The average resident slept only 54 minutes during these long hospital shifts.
Young doctors working in public hospital pediatrics departments earn their specialty after 4.5 years of such intensive work, but this often comes at the expense of their family life and threatens to increase medical errors by exhausted physicians.
During the past decade, many countries have limited medical residents’ night sifts to 12 to 16 hours – which seemed to their Israeli counterparts to be “dream” conditions. This change resulted mostly from a 2011 regulatory change by the European Union to reduce night shifts of the young doctors.
But during the COVID-19 pandemic, many hospitals around the country transitioned to 13-hour shifts in fixed teams (capsules) to reduce the risk of infection among them and increase expertise in treating the virus, followed by a 24-hour rest period at home.
Pediatricians at Assuta Medical Center in Ashdod and colleagues from Ben-Gurion University of the Negev in Beersheba and the School of Social Work of Hadassah-Hebrew University in Jerusalem decided to take advantage of this major change in shift length to see the effects on residents’ wellness, their ability to deliver quality healthcare and their acquisition of medical education.
They published their results in the latest issue of the Israel Medical Association Journal (IMAJ).
A total of 533 Israeli medical residents were surveyed with an anonymous, online questionnaire before the 13-hour shifts were launched on March 19, 2020 and then six weeks later, after the return to the 26-hour shift that returned on May 3rd.
The young physicians were asked to assess their current health status before and after the shift change and to rank their agreement with statements presented in the question from one to five – from strongly disagreed to strongly agree.
The researchers found that the pediatric residents showed a positive perception of the 13-hour shifts in almost all aspects, including home life, except for questions dealing with time available for research. They felt that their overall general wellness, ability to deliver quality healthcare and medical education experience increased during the shorter shifts. They added that larger groups should be questioned now that the pandemic is almost over as well extending the study to residency programs in other medical departments before final conclusions can be reached.
It is hoped that such positive conclusions will induce the Israeli government, especially the Treasury, to spend more money to switch to shorter shifts.
