Could have implications for aspiring physicians, those in medical school or residency, and people who may be patients at hospitals where medical residents work.
80 hours isn’t unreasonable in a week, but a 28 hour shift is insane. There’s no way in … I would want a resident providing me medical care who had been up 24 hours straight.
The work hour rule change only applies to interns (first year residents).
More senior residents (year 2 through the end of fellowship) already routinely work 24 hours shifts–28 if you include shift hand overs.
And most academic residencies (those at teaching hospitals, not at community based hospitals) have had interns in both surgical fields and medical fields working 24 hour shifts for the last 3 years as part of controlled study on the effect of longer shifts on patient outcomes. (FIRST for surgical specialties and iCompare for medical specialties.)
Why? Because patient outcomes are better when residents work longer shifts. There is better continuity of care and patients are less likely to “fall through the cracks” in the system when there are fewer patient hand-offs.
And the 80 hours/week limit---that's actually 80 hours/week when averaged over 4 weeks. So some works weeks can exceed 80 hours so long as the resident doesn't work over 320 hours in a given 4 week period.
I don’t want anyone who’s been awake for 20 hours near me. No one is fully awake and 100% if they broke their sleep cycle and don’t sleep after 18 hours in a 24 hours cycle, unless they took substances. That’s be wake up at 6 am, go to bed at midnight. At midnight, you’re drowsy. I can’t imagine operating on a patient in that state let alone later on.
Federal regulations limit trucker shifts to 14 hours. Likewise, pilots are limited to 14 hour shifts, with only 8 to 9 hours of flight time. Yet, for some reason, we think medical professionals should have 24 hour shifts, extendable to 28 hours in some cases?
It’s insane. Just plain insane. The thing is…it also weeds out people who are physically incapable of working this number of hours. They might make fine physicians, but they just cannot do this. Lack of sleep affects different people differently.
Don’t kid yourself, some of the residents and interns start using ritalin and other drugs to stay awake. Others live on Red Bull or caffeine pills. This can cause serious health problems, often later in life.
I’m not in the medical field and it all sounds crazy to me…BUT a very good friend who is a doctor (who did the long shifts back in his day) said that the long shifts allow interns to follow individual patients for long and continuing span of time and he feels that is very beneficial to both learning and training.
The 24 hours shifts are not a everyday occurrence for interns or residents. Usually at most they are scheduled once or twice a week (followed by mandated time off) and they only happen during a limited time frame–over one or two 4-6 weeks rotations each year. Residents do not work 24 hours shifts day after day, month after month, for years on end.
What many interns find more difficult than 24 hours shifts is night float–the 5pm to 7 am shift where they assume responsibility for as many as 50-60 patients–none of whom they have ever seen before.
I am not saying that 24 hours shifts are right or prudent. Just that they may not be as awful are you may think.
I think it used to be 36 hour shifts. Then, the Libby Zion case changed things. She was the daughter of a prominent newspaper journalist, for the NY Times I think, who died, it was claimed, because the residents who were treating her were too exhausted to monitor her and figure out what was happening. After that, shift lengths decreased.
I was in the hospital once for a minor procedure, but one with an inpatient stay of a few nights. An obviously very exhausted resident came into the room, which I shared with a roommate who was having an operation on her knee. He had the two of us confused. I don’t think this was desirable.
I can understand staying long hours if a resident has started a case and it needs to continue without a hand-off. Seeing patients the resident hasn’t seen before when the resident is exhausted is both pointless and dangerous.
Personally, I prefer not to have care by anyone who has been working for in excess of 12 hours, never mind 16 or 24 hours. I really question whether one can get optimal care from exhausted people. I know I am NOT my best when I’ve been awake and working too long. I especially would not want any of them doing surgery or things that require judgment when they are fatigued.