Should medical residents’ work hours be increased?
This month, the Accreditation Council for Graduate Medical Education will decide whether interns should be allowed the same 28-hour shifts senior residents work instead of the current, 16-hour shift maximum.
Kelsey Pendleton, MD, family medicine resident at St. Margaret Hospital in Pittsburgh, is one of many residents, physicians and watchdog groups not in favor of lifting the restrictions.
“My first year in a surgical residency was part of a pilot program in Pittsburgh that was studying whether 30-hour interns was just as safe or not as safe as interns who work 16 hours at a time,” Pendleton says. “I did several 30-hour calls. Around hour 20, I found myself making more mistakes caught by pharmacists, and I definitely wasn’t thinking things through. I started taking the easy route out because I was so exhausted. It was terrifying.”
The experience was so scary, Pendleton switched after that first year to a family practice residency, where the longest shifts she’s worked are 14 to 16 hours. “At the time, I was making simple mistakes, putting in information meant for one patient for another,” Pendleton says. “I’m not in favor of leaving it up to residents to decide if they are too tired to work or not. We’re in a prideful industry where people don’t want to admit their weaknesses, whether it is pressures from superiors or peers, or self-pride. People don’t want to say no. There needs to be limits.”
Sammy Almashat, MD, MPH, researcher and preventative medicine physician at Public Citizen’s Health Research Group, says the idea of no restrictions scares the public, too. Nearly 90 percent of respondents in a public opinion poll are opposed to lifting the work hour restrictions. “The guidelines themselves are abusive,” Almashat says. He believes that the hours will not be restricted unless the general public calls for change.
Popular online: Here is the PCP crisis solution and it's simple
Pamela Wible, MD, family practice physician and author of Physician Suicide Letters, points out that other professions that affect public safety have work-hour restrictions. Pilots can only fly eight hours at night or nine hours during the day due to Federal Aviation Authority restrictions, while truck drivers can only drive for up to 11 hours out of a 14-hour shift maximum, according to Federal Motor Safety Administration rules. Both of those professions are restricted to a maximum of 60-hour work weeks. “We need to call this what it is: human rights violations or abuse,” Wible says, adding that every day she receives dozens of calls from both residents and physicians who are struggling with extreme work hours with no room for bathroom or lunch breaks. The morning of this interview, Wible had already fielded seven phone calls from physicians.