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Doctors-in-training are still too exhausted, says a new U.S. report that calls on hospitals to let them have a nap.
Regulations that capped the working hours of bleary-eyed young doctors came just five years ago, limiting them to about 80 hours a week.
Tuesday, a panel of the prestigious Institute of Medicine recommended easing the workload a bit more: Anyone working the maximum 30-hour shift should get an uninterrupted five-hour break for sleep after 16 hours.
"Our committee's charge was not to focus necessarily on longer scheduling or shorter scheduling, but smarter scheduling to try to really identify the areas where we could have an impact in preventing excessive fatigue, both acute and chronic, that might contribute to medical errors," Dr. Daniel Munoz of Johns Hopkins University School of Medicine in Baltimore, a member of the panel, said in a telephone interview.
At issue is how to balance patient safety with the education of roughly 100,000 medical residents, doctors fresh out of medical school who spend the next three to seven years in on-the-job training for their specialty.
These junior doctors frequently are the front-line medical staff on duty around the clock in teaching hospitals. The long hours are in some ways a badge of the profession; doctors cannot simply clock out if a patient is in danger.
But sleep deprivation fogs the brain, a problem that can lead to serious medical mistakes. So in 2003, the Accreditation Council for Graduate Medical Education issued the first caps. Before then, residents in some specialties could average 110 hours a week.
As an illustration of the fatigue residents may experience, the panel noted that research has shown they have an increased risk of being involved in traffic accidents or falling asleep at the wheel after an extended-duty shift.
The panel urged the ACGME to adopt the recommendations within two years. The independent Institute of Medicine provides advice to U.S. policymakers.
The accreditation council didn't immediately say if it would follow the recommendations.
Common violation
The government asked the institute to study the current caps. Violations of current limits are common and residents seldom complain, the committee found. While quality of life has improved, there's still a lot of burnout.
And despite one study that found residents made more errors while working longer shifts, patient safety depends on so many factors that it is impossible to tell yet if the caps helped that problem, the report said.
It also recommends:
- Experienced physicians should more closely supervise residents.
- Better overlap of schedules during shift changes to reduce chances for error as one doctor hands patients' care over to the next.
- Increase mandatory days off each month, and extend hours off between shifts depending on how long the resident worked, during day or night.
"Cutting hours alone won't do it," added Dr. Ann Rogers of the University of Pennsylvania School of Nursing in Philadelphia, who also served on the committee.
"We need to pay attention to work load. We need to pay attention to supervision. The whole package will make a difference. Without it, you could end up with a more severely stressed resident trying to do more work with less hours."
Rebecca Sadun of the American Medical Student Association said the recommendations are "unambiguously a step in the right direction." She said the 2003 limits have proven to be insufficient because the current 30-hour shifts do not enable residents to remain at a high level of functioning throughout.
Sadun, a medical student at University of Southern California's Keck School of Medicine, added that her association hears many accounts from residents about how the current 80-hour work weeks in reality are 100-hour work weeks, with school administrators insisting that residents fill out time logs dishonestly.
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The Associated Press and Reuters contributed to this report.
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