The Accreditation Council for Graduate Medical Education (ACGME), the governing body for post-graduate medical education, is strongly considering changing their regulation on resident work hour restrictions this year.
The issue: whether young doctors-in-training (commonly referred to as “interns” and “residents”) should be allowed to work 28-hour shifts, instead of the current maximum of 16 hours. The public needs to care deeply about this issue, for many reasons.
1. Sleep-deprived doctors can hurt patients.
Do you want a healthy well-rested doctor taking care of you, or an exhausted one? A 2004 randomized study looked at residents working in an intensive care unit. Researchers found that doctors made more errors when working longer hours. When doctors are on a shift, they are expected to work, not sleep. When sleep deprivation sets in, medical errors increase. Why risk increasing medical errors? On Feb. 3, 2017, a Public Citizen petition with 67,000 signatures was delivered to the ACGME, begging the board to reject this new proposal.
2. Sleep deprivation causes motor vehicle accidents.
The term “resident” refers to a doctor in a training program. The term originates from its obvious and simplest definition, meaning one who resides in the hospital. In his book “The Youngest Science,” Dr. Lewis Thomas explains that no one in his 1937 training program was married. In his words, “it would have been unheard of.” While many residents today are married, many would argue that the attitude towards work-life balance for trainees has not changed much since 1937, when Dr. Thomas completed his own internship.
After a 36-hour hospital shift, does the hospital care where a resident sleeps? No, they don’t. Today’s residents no longer have accommodations to sleep at the hospital, so they must somehow get home to sleep. That oftentimes means they will drive home; research shows this can mean getting into a serious accident.
3. Residents are a captive and abused audience.
What is the ACGME’s goal? Purportedly, to improve doctors’ training. We have some great ways to do this without making residents suffer. If the ACGME wants to investigate ways to improve medical education, all they need to do is ask in a meaningful way. They shouldn’t rely on forced “yeses” from trainees, who have no real choices. Trainees know they must complete their training or lose their careers, so they are conditioned not to complain. Doctors have put too much time, money, and effort into their medical education to risk upsetting their superiors by complaining about their residencies. It’s an unfair situation and it needs to be remedied immediately. As I’ve previously published, there are many ways to do this, including by polling past residents who aren’t afraid to speak the truth and by asking questions programs may not want to know the truth about, such as: “If a resident could switch to a different program at another hospital, would s/he choose to do so?” Another important advance would be to expand the Committee of Interns and Residents, the CIR union, who could effectively lobby for trainees but currently only represents a 14,000 out of a total 118,962 trainees.
4. Doctors are dying by suicide.
In the words of Dr. Pamela Wible, TED speaker, physician, and activist, “Each year more than one million Americans lose their doctors to suicide.” It’s the medical field’s open dirty secret that so many medical students, residents, and active physicians kill themselves.
In her TED talk, Dr. Wible shares that, “Sleep deprivation is a torture technique.” Residents are a captive audience without any resources. They can’t complain. They can’t change their work environment. They can’t switch training programs. They must do as their told without causing trouble, or else. Or else what? They’ll be kicked out of the program, without any job prospects and usually with hundreds of thousands of dollars in debt. Forcing doctors to work longer hours is cruel.
5. There are too many other ways to improve resident education.
The ACGME needs to take real steps to improve medical education instead of taking the easy way out. Longer shifts won’t make doctors learn better. It will only make more senior doctors feel better about themselves, when they believe “if I got through it, so should the younger doctors.” These sentiments are lazy and selfish, and are truly reminiscent of fraternity hazing rituals.
Where is the ACGME review of the non-existent policies on maternity leave for residents?
Where is the ACGME outcry of trainee suicides?
Let’s start focusing on quality, not quantity. Let’s look for the hard answers, not the easy ones.