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The plight of resident physicians is so well-known it has become a cliché. Turn on any medical drama on any television network and you will find beleaguered residents working for days at a time, chugging coffee, dozing off between patients, and surviving on little to no sleep. Everyone accepts it, but now people in the fields of medicine and sleep research are asking how much damage those sleep deprived residents are doing to their patients.
In a recent issue of the Nature & Science of Sleep, a group of national leaders in the areas of health, medicine, patient safety, and research urged the medical establishment to make significant changes to the way resident physicians are taught and work in our hospitals. Alarming research indicates that the 24+ hour shifts many residents work jeopardizes the health of their patients and puts their own safety at risk. Although there are new standards from the Accreditation Council for Graduate Medical Education (ACGME), which governs the residency program for U.S. doctors that will go into effect on July 1, the experts say it isn’t enough. They want more widespread changes, more accountability, and stricter enforcement.
Resident physicians are essentially graduate students in the field of medicine. The way the residency program works leaves residents who are over-worked or unhappy with their program no place to turn. Many need to complete the residency program in order to be eligible for board certification and so they must put up with any work conditions and put in the hours required in order to stay in the program. Residents work 80 or more hours a week and can be on shift for as many as 30 hours at a time with only 5 hours within that 30 that they can sleep They are often on call working an overnight shift every third night and may have as little as 10 hours off between 30 hour shifts. This means that on any night, in any hospital in the country, the doctor treating you may have worked 50 of the last 75 hours and slept for only 10 hours. That is the equivalent of almost 3 days with barely 1 night’s worth of sleep.
Many other professions in the U.S. where sleep deprivation can have serious consequences and risk loss of life are strictly regulated and enforced. Look at over the road truck drivers as an example. They are limited to driving no more than 11 hours within one 14 hour on-duty shift after which they must be off-duty for 10 hours before the next 14 hour window can start. They are prohibited from driving after they have been on duty for more than 60 hours over the course of 7 consecutive days and then cannot drive again until they have been off-duty for 34 consecutive hours. A resident physician could be on duty for more hours than that in 3 days and have only 10 hours until they have to do it again.
Pilots can only fly 8 hours in every 24 hour period and they have a mandatory rest of 8 hours in every 24 hours in order to fly. The people who drive the trucks that haul our goods across the country and the pilots who fly the planes that take us from coast to coast are more tightly regulated than the people we look to for life and death, split second decision making. After 24 hours without sleep, mental capacity is comparable to that of someone who is intoxicated but the doctors we depend on to heal our children may not have slept for more than 15 hours in the last 60.
In order to combat the shocking research and alarming poll results in which 1 in 20 residents admitted that sleep-deprived mistakes caused the death of a patient, this group of experts wants reform across the residency program. As a starting point, they have recommended strict 12-16 hour shift limits that are enforced at all hospitals and that must be complied with in order for a residency program to get the support and funding of the Medicare program that finances most of the U.S. resident physician programs. Additional recommendations include supervision of an attending physician for all hospital admission and mandatory in-house supervision of all residents in critical care areas like the emergency room and intensive care unit. There are several high level recommendations that the experts feel need to be made immediately in order to improve resident physician education and safeguard patients in their care.
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