The July Effect: Is It Safe to Get Sick?

Medical interns assessing a patient
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You may have heard of the legendary hospital July Effect. July is the month that new interns graduate from medical school and start real life, hands-on medical training. In July, most senior level residents also graduate from one year of training and move on, starting the next level of responsibility and independence.

Those who have heard of the July Effect fear becoming unexpectedly ill during the month of July because trainees are less experienced than they are expected to be in any other month of the year, such as December or April.

A stroke is one of the more subtle medical conditions, difficult to diagnose, and full of nuances that take practiced skill to detect. Stroke treatment is so involved that it requires meticulous, detailed care.

So, should you worry about the July Effect? Is there really any indication that patients receive better or worse medical care at different times of the year? What does that mean for you as an empowered patient?

Does the July Phenomena Impact Stroke?

As it turns out, the July changeover in resident duties does not have an impact on patient stroke outcomes. A 2015 study published in the Journal of Stroke and Cerebrovascular Research reported that patients who experience strokes in July, when the academic year-end changeover occurs, do not have different outcomes than patients who experience strokes during any other month of the year.

Resident Doctor Shifts

Even more surprisingly, the long hours and irregular shifts that doctors-in-training have to work don’t affect your stroke care or overall outcome after a stroke.

Physician residents notoriously work long, consecutive hours and have to work overnight—in case you get sick at any time of the day or night.

A recent study published in the Journal of Cerebrovascular Disease examined resident work hours and the impact on stroke outcome. The study authors reported that changes in physician-in-training work hours do not affect patient stroke outcome.

What If You Have a Stroke in the Middle of the Night?

Another research analysis evaluated stroke outcomes in relation to the time of day of emergency room visits and hospital admission. Interestingly, you need not fear going to the hospital for a stroke at an unusual time.

It doesn't matter what time you go in—whether during a quiet nighttime, a busy evening, or fresh in the morning—it doesn't change the outcome. In fact, your outcome is highly likely to be worse if you delay getting medical attention for any reason.

Why Doesn't the July Effect Impact Stroke?

Because stroke is so significant, most hospitals have already developed stroke protocols and have established teams staffed with experienced health care professionals that provide a number of checks and balances in your care.

New physician residents-in-training generally learn the nuances of stroke by examining a stroke patient’s progress over time but are not given the authority or responsibility to make huge decisions, such as whether to evaluate for a stroke, whether to send a patient home, or whether or not to administer potent blood thinners.

In teaching hospitals, doctors spend a great deal of time reviewing patient’s symptoms, physical examination findings, test results, medications, and care plan.

Teams include senior physicians, junior physicians, and nurses. By the time a doctor is given responsibility to make decisions about stroke patients, he/she has personally seen hundreds of stroke patients, has been questioned about the tough details frequently, and has taken many difficult examinations.

The July Effect and Your Stroke Care

The biggest thing you may notice if you have to go to the hospital for a stroke in July is that some of the doctors-in-training may spend more time with you and might confirm more details about your care than usual. Enjoy the extra attention and rest assured that this will not negatively affect your outcome at all.


Academic year-end changeover and stroke outcomes, Park TH, Redelmeier DA, Li S, Pongmoragot J, Saposnik G; Investigators of the Registry of the Canadian Stroke network (RCSN) for the Stroke Outcomes Research (SORCan) Working Group, Journal of Stroke and Cerebrovascular Disease, February 2015

The impact of Accreditation Council for Graduate Medical Education duty hours, the July phenomenon, and hospital teaching status on stroke outcomes, Alshekhlee A, Walbert T, DeGeorgia M, Preston DC, Furlan AJ, Journal of Cerebrovascular Disesase, May-June 2009

The role of admission timing in the outcome of intracerebral hemorrhage patients at a specialized stroke center, McDowell MM, Kellner CP, Sussman ES, Bruce SS, Bruce RA, Heuts SG, Sander Connolly E, Neurological Research, February 2014

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