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New Rules On Medical Residents' Hours Spur Debate

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New Rules On Medical Residents' Hours Spur Debate


New Rules On Medical Residents' Hours Spur Debate

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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We turn, now, to an ongoing debate in healthcare: The amount of hours doctors spend on the hospital floor. After today, resident physicians in training will be working shorter hours. New rules are going into effect that will limit first-year residents to 16 hour shifts. Right now, residents work up to 30 hours at a time.

Reporter Jenny Gold, of Kaiser Health News, has more.

Ms. JENNY GOLD: This is the second time in the last eight years that the rules for residents have changed. In 2003, the Accreditation Council for Graduate Medical Education limited residents to 80 hours a week. But they were still allowed to work 24 to 30 hour shifts. That's set off a debate in the medical establishment, between those who say long hours create fatigued doctors - who make more mistakes; and those who argue they're an essential part of medical training.

Dr. EMIL OWEIS (Physician): Hey Mr. Dodson.

Mr. DODSON: Hello.

Dr. OWEIS: How are you?

Mr. DODSON: I'm fine.

Dr. OWEIS: I'm Dr. Oweis. I'm one of the residents from the internal medicine team that's taking care of you.

Mr. DODSON: Okay.

GOLD: Dr. Emil Oweis just finished his first year as a resident at the Washington Hospital Center in Washington D.C. He's a tall, serious man of 26, in wire-framed glasses and a white coat. He holds out his hand to Barry Dodson, whose been hospitalized for asthma.

Dr. OWEIS: Sit up please. I'm just going to listen to your chest, okay?

Mr. DODSON: All right.

Dr. OWEIS: Deep breath for me.

GOLD: Right now, Oweis is about nine hours into his shift. For most people, this would be the end of the day. But Dr. Oweis's shifts can last up to 30 hours when he's on call.

Dr. OWEIS: I've been alive and functional 27, 28, 29 hours into a shift. You are definitely going to be tired. But you do it once or twice, you'd probably hate it. You do it for six months, you start getting used to it.

GOLD: But some studies suggest that residents like Oweis are not at their best after so many hours of work and tend to make more mistakes. The new set of regulations will limit shifts to 16 hours, but only for first year residents. Second and third years will still be allowed to work 24 hours, with another four hours tacked on for follow-up care.

Dr. Lucian Leape of the Harvard School of Public Health is a leading advocate of shorter shifts. He says the new rules don't go nearly far enough.

Dr. LUCIAN LEAPE (Physician, professor, Harvard School of Public Health): I think 12 hours is the right length. You talk with any doctor or any nurse who's been working hard all day, 12 hours is a long day. It's 50 percent longer than most people work.

GOLD: Leape says it's time for OSHA, the federal agency in charge of worker safety, to get involved. OSHA is considering the request.

But Dr. Thomas Nasca says long shifts during training are important for good patient care. Nasca is CEO of the organization that put the new rules in place.

Dr. THOMAS NASCA (CEO, Accreditation Council for Graduate Medical Education): Let's say you're having a difficult labor and your labor lasts beyond 12 or 14 or 16 hours. You may have some complications. Who is better to take care of you during the final phases of that labor than the physician who's been caring for you all the way through?

GOLD: Nasca says limiting shifts for first year residents was the right thing to do. Those doctors are new and need to be eased into the profession. But he says older residents need those long hours to get ready for life as a doctor. Once they finish their training, their hours are unlimited.

Mr. NASCA: We need to remember that, at the end of this training, these residents must be exquisitely well trained. And we must teach them how to recognize and manage fatigue, because they will encounter fatigue when they care for patients in actual clinical practice.

GOLD: Dr. Roland Goertz runs a medical center in Waco, Texas that trains 36 residents at a time. He's also president of the American Academy of Family Physicians. He says even the change for fist year residents is troubling.

Dr. ROLAND GOERTZ (President, American Academy of Family Physicians): The biggest concern that I have is the intentional creation of necessary handoffs of care.

GOLD: Handoffs are where one doctor has to transfer information about a patient to the next doctor on duty.

Dr. GOERTZ: And we know from previous studies and research, that those handoffs potentially are where a significant errors can occur in care.

GOLD: The change is also expected to cost hospitals and clinics nearly $250 million. And it could mean more work for older residents who have to pick up the slack.

For NPR News, I'm Jenny Gold.

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