Physicians in training, commonly known as medical residents, have always worked long grueling hours that sometimes have lasted up to 30 hours straight without any breaks. In fact, the term resident is derived from the notion that these physicians in training spend such long hours in the hospital that they “reside” at the hospital. For many medical residents, they spend so much time in the hospital that it often becomes a second home. Medical residents work together for such long durations of time that outside relationships suffer and many times fail. The long work hours, that are required to become a competent physician, cause sleep deprivation and can lead to work errors. When the health of patients is involved, medical errors should be avoided and eliminated completely. Residents and residency program directors have tried to balance this sleep – work issue for decades. There have been several notable cases of patient harm due to sleep deprived physicians. In 1989, New York State implemented into law the recommendations as outlined by the Bell Commission to limit medical resident work hours to 80 hours per week. This law, also known as the Libby Zion law, was a direct result of the nationally notable death of Libby Zion who died while under the care of overworked medical residents. Beginning on July 1, 2011, all first year medical residents will be limited to only 16 hour work shifts. This new work hour limit was the result of an investigation lead by a group of 26 physicians and health policy experts that met at Harvard Medical School in the summer of 2010. Their recommendations were published today online in the journal Nature and Science of Sleep. They had met to discuss the Institute of Medicine’s guidelines for limits on medical resident work hours, which were published December 15, 2008. Based upon this review and the guidelines set forth by the Institute of Medicine, the Accreditation Council for Graduate Medical Education (ACGME) has adopted the 16 hour per shift limit for first year medical residents. More senior medical residents will not have this new work limit. The ACGME sets rules and establishes accreditation criteria for residency training programs and thus this new work limit is expected to be widely adopted. The other recommendations that were outlined in the report include identifying excessive workloads, requiring attending physician supervision of admissions, limiting resident physician moonlighting, and reassigning some types of paperwork and blood draws to other hospital personnel. Hopefully these new work hour limits and recommendations will allow medical residents to obtain more sleep, work without sleep deprivation, and provide an environment for safer medical care and education.
Alexander B. Blum et al. “Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety” Nat Sci Sleep published online June 24, 2011 pages 47-85