It's way past time for Congress to come to the aid of the
medical residents who are among our most important providers of hospital care.
The young doctors-in-training are being forced to work 80 hours a week, often
as long as 30 hours in a single shift.
Congress has ample proof of the urgent
legislative action to lessen the incredible workload of the highly exploited
trainees, in part to protect patients from the possible errors of
sleep-deprived residents. The proof came in a recent report Congress had requested from the widely respected
Institute of Medicine because of concern over the treatment of residents and
its possibly dangerous effects on patient care.
The institute found that exhaustion - and possible error
- is common among the 100,000 residents in the nation's hospitals. They work as
residents for three or more years after graduating from medical school in order
to be certified as physicians, and are relied on heavily to ease the workload
of the hospitals' staff doctors, nurses and other regular employees.
The institute's report didn't challenge the 80-hour workweek
and 30-hour shifts that were established for the doctors-in-training by the
national accrediting organization for residency programs five years ago, when
the average workweek was 110 hours and work shifts as long as 36 hours. But the
report did recommend that residents work no more than 16 hours straight.
working the maximum 30-hour shift would have to take a five-hour nap after 16
hours on duty. The report also recommends giving residents more days off and
extending their time off between shifts.
Some other medical experts and activists complain that
the institute's recommendations don't go far enough to insure genuine reform.
They say it would be impossible, for instance, to enforce a nap requirement and
that it's highly unlikely, in any case, that a resident could possibly get five
hours of uninterrupted sleep in the midst of a shift. It would make more sense
to simply ban any shifts longer than 16 hours.
How hospital administrators will respond to the
recommendations is debatable, considering their response - or lack of it -- to
previously suggested reforms.
The current regulation mandating 80-hour workweeks is
widely ignored. Some administrators actually have contended that working even
more hours is helpful to a doctor's education because it teaches him or her to
make decisions under stress.
As Boston pediatrician Joshua M. Sharfstein noted,
"Our medical establishment remains wedded to an excessively grueling,
risky, and outdated system of training new physicians." He said the
traditionally long hours of the young doctors-to-be might be acceptable
"if there were data to
support the notion that heroic work schedules are a necessary part of a
physician's training. But no such data exist."
New York M.D. Abigail Zuger suggested that working such
schedules might be of some educational value nevertheless - by helping trainees
develop empathy for patients: "Stay awake every night for three years,
tired, aching, nauseated and terrified that despite the very best intentions in
the world you are about to make a terrible mistake. With any luck at all you
will get a vague idea of how it must feel to be truly sick, powerless and
frightened - and with any luck the lesson will stick even after it is all
Ideally, the 80-hour limit should be just a starting
point toward the limits of 50 to 60 hours - or less -- that are common in most
other industrialized nations. Whatever the limit might be, federal oversight
seems necessary, as the Institute of Medicine recommends. But even more than
that, there should be a firm federally-regulated limit, as there is on the
working hours of airline pilots and long-haul freight truck drivers for reasons
Congress might also need to come up with funding to help
hospitals meet the cost of hiring other medical workers to do some of the work
now done by residents during their exceptionally long workweeks. The institute
estimates that would cost $1.7 billion.
Eighty-hour workweeks, 30-hour workdays. Surely we can do
better than that for the young men and women who are essential to the present
and the future of our vital
medical care system.
Copyright (c) 2008 Dick Meister