Overworking medical residents continues and is a cause of medical errors.
In 2003, the Accreditation Council for Graduate Medical Education enacted new "rules" to govern the number of hours medical residents could be required to work. The new rules were a response to studies which confirmed that fatigue was a major factor in medical errors and in serious resident health problems such as depression and motor vehicle collisions. The Insititute of Medicine issued new recommendations this month, suggesting that residents should not be allowed to work more than 16 hours without a mandatory five-hour sleep break, they should get one full day off per week, and at least two back-to-back days off each month. The Institute of Medicine is a branch of the National Academy of Science.
The current rules mandate only a maximum work-week of 80 hours, and shift maximums of 30 hours. They require only four days off per month and do not require a day off per week. Even these absurdly demanding rules are honored only in the violation: the Institute reported widespread violation. The head of the panel that supervised the study, Dr. Michael Johns of Emory University, said the evidence strongly supported the conclusion reached by the panel: residents are over-worked and their fatigue causes errors.
The panel's report runs 324 pages and is the latest in an attempt to improve the quality and safety of American medicine. The panel's supporting data shows that eighty-four percent of first-year residents worked shifts that exceeded the current "rules". Almost half worked more than 80 hours per week. At Vanderbilt University in 2005, for example, 85 percent of residents reported violating the 30 hour shift limit: wouldn't that be comforting news to the patients they were caring for? A 1996 study found that pediatric residents were averaging only 3 hours of sleep per night while on call. That's who I want taking care of my baby in an emergent situation: a brand new, green doctor who's been sleeping 3 hours a night.