Tired Doctors: Group Calls For Better Residency SchedulingDec 3, 2008 | Parker Waichman LLP
The Institute of Medicine is recommending that new doctors workloads be eased a bit, saying that young doctors - and their patients - may benefit from sleep breaks.
ECanadaNow.com noted that release of the report may enable more rest for resident. Today, residents are exhausted when treating patients, which could result in “serious medical errors.” The vast majority of residents—a whopping 75 percent—reported being “burnt out” before ever reaching the 80-hour weekly limit, said ECanadaNow, which noted that even 30-hour shifts might be excessive.
According to the Associated Press (AP) noted, regulations passed in recent years limited the amount of hours residents were allowed to work to 80 per week. However, the recent Institute of Medicine’s report entitled, “Resident Duty Hours: Enhancing Sleep, Supervision and Safety” indicates that residents are still too tired and their hospitals should provide opportunities for trainees to get some rest.
USA Today noted that it was the Accreditation Council for Graduate Medical Education (ACGME), the organization that is responsible for residency programs that instituted the 80-hour-per-week limit back in 2003. That limit, said USA Today, was to be averaged over a four-week period and should ensure that no more than 30 hours be worked at any given time. In the past, residents typically worked over 100 hours or more weekly, said USA Today.
Yesterday, an Institute panel recommended that those individuals working the “maximum 30-hour shift should get an uninterrupted five-hour break for sleep after 16 hours,” the AP said. “Our committee's charge was not to focus necessarily on longer scheduling or shorter scheduling, but smarter scheduling to try to really identify the areas where we could have an impact in preventing excessive fatigue, both acute and chronic, that might contribute to medical errors," panel member Dr. Daniel Munoz of Johns Hopkins University School of Medicine told the AP.
The Salt Lake Tribune spoke with surgery intern Brent James, who said he often worked 90-to-120-hour weeks, taking late night calls he was unable to remember the following day. James has since been elected to the Institute and agrees with the call for reduced resident work hours, which are expected to improve training and reduce the chances of fatigue-related medical errors. "We know that if people are too tired they will make mistakes," James told the Tribune.
The Tribune noted that the Institute report suggests that residents not work long hours without rest, moonlighting be restricted, and residents take more days off. However, the Institute did not suggest a change to the 2003 80-hour-per-week maximum. The Tribune pointed out that despite the cap on weekly hours, the 80-hour limit is often exceeded, indicating closer ACGME monitoring might be called for.
Although some feel additional reductions might hinder residents’ training, the AP quoted Rebecca Sadun of the American Medical Student Association who said the recommendations are "unambiguously a step in the right direction. Sadun cited the current limits as being “insufficient” as they do not allow residents sufficient rest throughout the course of their shifts.