Is Raising Resident Hours the Right Thing to Do?

It was March 4, 1984 and a young college freshman was admitted to New York Hospital suffering from fever, chills and an unexplained flailing of her arms and legs. While she had a history of drug use and depression, hospital interns gave her a medication that was known to react with antidepressants in a potentially life-threatening way and then strapped her to a gurney in an effort to keep her from hurting herself—eight hours later she was dead.

Medical errors, a topic I discussed in a recent blog, are not uncommon—in fact, a recent Johns Hopkins study claims they account for over 250,000 deaths in the U.S. each year. While many of these are often attributed to mix-ups or miscommunications, there are other reasons as to why such mistakes happen. Currently, there is much focus on the topic of medical residents and the exhaustive schedule that they keep. Many of our finest hospitals have these fresh-out-of-med-school doctors making life-altering judgement calls while their minds are numbed by stress and dulled from lack of sleep, yet a governing body is looking to increase the number of hours they can work in any given shift. Is this really a change we should be implementing?

Prior to the aforementioned incident, there was no limit as to the number of consecutive shifts and/or total number of hours a week an intern could work at a hospital during their residency. But this time, the victim was the daughter of then-noted New York Times writer, Sidney Zion. He was able to expose the situation to millions of readers—resulting in the formation of a commission, ongoing evaluation and, in 1989, residency guidelines for the state of New York that dictated no more than 24 consecutive hours and 80 hours a week could be worked by any intern. Adopted nationwide, data showed there was room for improvement and, in the early 2000s, the Accreditation Council for Graduate Medical Education (ACGME) further restricted first-year residents by limiting them to only 16 consecutive hours.

Fast forward to today. Changes are on the horizon, as not everyone sees the value of the guidelines currently in place. The ACGME has recently proposed increasing the number of consecutive hours that can be worked by a first-year resident from 16 to 28. That’s four more hours, the equivalent of half a day’s work for most of us, than previously allowed going all the way back to the Libby Zion Law of 1989.

In defense of this new position, the ACGME points out that residents will still be restricted to a cap of 80 hours per week. So they are not working more hours overall, just experiencing longer, more concentrated shifts—something experts say will better mimic the work schedule of future healthcare providers. The ACGME also believes that the longer shift duration means residents can avoid having to hand off patients to other interns in the middle of certain treatments, a critical point in time that previously could have led to mix ups and mistakes.

Opponents say that such arrangements will only make a bad situation worse, lessening the quality of care and opening the door to even more medical errors. At the crux of their argument is the condition of fatigue from sleep deprivation. A director of Public Citizen’s Health Research Group, Dr. Michael Carome, states that “Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public.” One study in particular, led by Kevin Volpp, MD, PhD, and professor of medicine at the University of Pennsylvania, was recently published in the Journal of the American Medical Association (JAMA) and showed through video footage how mental alertness degraded with lack of dedicated sleep. As a possible solution, Volpp’s team tested the idea of “power naps” for residents in order to maintain a higher level of mental acuity. While the results were promising, one must question if this is what we as potential patients are comfortable with—is this going to result in better doctors ready to handle the stresses of their profession, or is it simply going to burn out residents before their time and compromise hospital care in the process?