Sun Sentinel Palm Beach Edition
Group proposes longer shifts for young doctors
The private group that oversees physician training in the United States has proposed rolling back rules so that young doctors just out of medical school can work shifts as long as 28 hours.
The proposal relaxes work restrictions put in place in 2011 when mounting evidence showed that exhausted residents — the term for doctors in training — were endangering both patients and themselves. Currently, first-year residents are restricted to 16-hour shifts.
Studies show that residents make more potentially deadly errors in caring for patients the longer they work.
The extended shifts also expose residents to an increased risk of car accidents as they drive home from work. At UCLA, nearly 20 percent of residents said in a 2007 survey that they had fallen asleep while driving because of work-related fatigue.
Doctors pushing for the change say the current shift limits can jeopardize patients by forcing residents to leave at critical times. They also say grueling hours prepare trainees for the future, when they will practice unsupervised.
“Training to become a practicing physician can be compared to training for a marathon,” said Thomas Nasca, chief executive of the Accreditation Council for Graduate Medical Education, in announcing the proposed change. “With enough experience comes resilience and the ability to perform under expected, sometimes challenging conditions.”
A final vote on the proposal is expected in February.
Some physicians and consumer groups have blasted the proposal, pointing out that it goes against findings by the Institute of Medicine, which concluded in 2009 that having doctors work more than 16 consecutive hours was dangerous for patients and doctors.
“This is deeply troubling,” said Charles Czeisler, a professor at Harvard’s Brigham & Women’s Hospital, who has studied what happens as residents work extended hours. “It is very well established that staying awake for 24 hours severely degrades performance.”
In one trial, Czeisler and his colleagues found that interns — residents in their first year — working in the intensive care unit for 24 hours or more made serious medical errors 36 percent more often than those working shorter shifts.
At times, the Harvard researchers found residents sleeping while standing up, Czeisler said.
Under the council’s proposal, interns would have the same 28-hour limit as residents with more experience.
The proposal would also let all residents work longer than 28 straight hours in rare cases in which they are needed for a patient’s care, but with no need to document why the extended hours were necessary. And it would eliminate a requirement that residents get at least eight hours off after shifts of less than 24 hours.
The plan keeps rules in place that say residents cannot work more than 80 hours a week, averaged over four weeks.
And because residents are at risk of depression and anxiety, in part because of their long hours, hospitals must begin providing 24-hour access to affordable mental health treatment for them under the plan.
Surgeons have been especially critical of the current restrictions, which have at times required residents to leave a surgical team in the middle of an operation.
The restrictions on how many hours the young doctors can work have also been expensive to teaching hospitals, which had to hire more staff to do work once performed by the physician trainees.
“Residents represent free labor,” said Andrew Schumacher, a resident at Kaiser Permanente in Los Angeles.
Schumacher noted that four hospital executives sit on the council’s 35-member board that will vote on the proposal. He said he believes those executives have a conflict of interest that could influence their vote.
Medicare pays the teaching hospitals as much as $130,000 or more a year for each resident. The hospitals then pay residents just a fraction of that, with many receiving a salary of around $60,000, with no overtime.
The council proposed relaxing the rules after a study led by Karl Bilimoria, a professor of surgery at Northwestern University, concluded there was no difference for surgery patients’ safety when hospitals allowed residents to work longer than the current national limits.
But some doctors say the study was poorly designed.
“These were trials run by physicians who wanted to see the rules overturned,” said Sammy Almashat at Public Citizen’s Health Research Group.
“We don’t let pilots stay awake for 28-hour shifts,” he added, “because we know the consequences.”