June 1, 2010
Public Strongly Supports Substantially Reducing Work Hours for Resident Physicians, New Research Finds
Only 1 Percent of General Public Supports Widespread Practice of Resident Physicians Working Shifts Longer Than 24 Hours
WASHINGTON, D.C. – The American public greatly underestimates the extended hours currently worked by resident physicians nationwide and overwhelmingly disapproves of shifts lasting longer than 24 hours, which are currently required by teaching hospitals. New findings, published in today’s edition of the online journal BMC Medicine, indicate that Americans strongly favor tighter regulation of the number of consecutive hours that resident physicians are allowed to work. This is the first systematic study of public perceptions of resident work hours.
The authors of the manuscript, which included academic experts as well as consumer and labor advocates, found that 90 percent of Americans believe that the maximum shift duration for resident physicians should be 16 hours or less, as recommended by the Institute of Medicine (IOM). The IOM concluded in 2008 that allowing resident physicians to work more than 16 consecutive hours without sleep is unsafe both for patients and resident physicians themselves. More than four of five respondents in the study believe patients should be informed if the doctor treating them has been working for 24 hours; a similar majority of respondents said that if told that their doctor had been awake for a day, they would request care from a different doctor.
The Accreditation Council on Graduate Medical Education (ACGME), the group that oversees the training of physicians in the U.S., has yet to implement the IOM recommendations. The ACGME currently allows resident physicians to work for 30 consecutive hours and allows such extended shifts to occur up to twice per week. The ACGME has been reviewing the IOM recommendations for limiting resident physician work hours for the past 18 months and is expected to announce its decision later this month.
The national telephone survey of a representative sample of 1,200 U.S. adults revealed that:
• Only 1 percent of the general public supports shifts longer than 24 hours for medical residents. Current work hour rules permit residents to work 30-hour shifts twice weekly.
• The majority of respondents said they believe that resident physicians work shifts of less than 12 hours.
• 81 percent of the general public believes that reducing resident physician work hours would be very or somewhat effective in reducing medical errors.
• 81 percent of the public believes that patients should be informed if a treating resident physician has been working for more than 24 hours; 80 percent said they would then want a different doctor.
• When asked about specific recommendations of the IOM, four of five respondents support limiting the duration of individual work shifts to 16 hours, capping weekly work hours at a maximum of 80 hours in any single week and ensuring that medical residents have at least one day off per week.
• 68 percent favor the IOM recommendation that resident physicians not work more than 16 hours over an alternative IOM proposal that would permit resident physicians to remain in the hospital for 30 hours, as long as they were provided the opportunity to sleep for five hours without interruption after 16 hours of work.
“Our research shows that the general public clearly does not support continuing to allow hospitals to schedule resident physicians to work for 24 consecutive hours or more,” said lead author Dr. Alex Blum, a health and evidence policy fellow at Mount Sinai School of Medicine. “Though the debate about resident work hours has raged for decades, this is the first time we have heard directly from our patients. Our patients underestimate the hours that resident physicians currently work and are concerned about the safety of their working 24-hour shifts.”
Added Dr. Charles Czeisler, a senior author of the study and Baldino professor of sleep medicine at Harvard School of Medicine, “The American public realizes that the 19th century practice of scheduling resident physicians to work marathon 24-hour shifts is unsafe for patients. The 108,000 resident physicians in the U.S. provide much of the direct medical care in our nation’s teaching hospitals, where more than half of all hospitalized patients in the U.S. receive their care. Implementation of a 16-hour work-hour limit for resident physicians, as recommended by the IOM, is long overdue.”
Patients are very concerned about being cared for by a fatigued physician. Four-fifths of the general public believes that reducing resident work hours would reduce medical errors, the study found.
Patient safety groups have formed a coalition to bring light to the issue of resident hour reform and created a website, www.WakeUpDoctor.org, to raise public awareness of the problem.
“The leaders within academic medicine who are resisting these sensible changes are out of step with the public, and that jeopardizes the notion of patient-centered care and threatens the health of patients,” said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen, a coalition member.
Added Dr. Farbod Raiszadeh, a study co-author, president of Committee of Interns and Residents/SEIU and clinical fellow in the Montefiore Medical Center at the Albert Einstein College of Medicine, “It is patients who bear the brunt of substandard care sometimes delivered by mistakes made by fatigued and overworked resident physicians. Finally their voices have been heard.”
Fatigue is common among medical residents, as are medical errors, the researchers noted.
“One of five resident physicians admits to making a fatigue-related error that has injured a patient, and one in 20 admits to making a fatigue-related error that has resulted in the death of a patient,” Czeisler said. “Working for 24 hours without sleep impairs performance to a degree that is comparable to being legally drunk. Patients have a right to be concerned for their safety when doctors work marathon 24-hour shifts. Reducing resident physician work hours is an effective way to improve patient safety.”
“The finding that patients do not find it acceptable to be cared for by fatigued, poorly supervised residents should not come as a surprise,” said Helen Haskell, founder of Mothers Against Medical Error, a coalition member. “The fact that the public is almost completely unaware of the actual working conditions of medical residents is symptomatic of the gulf in thinking between patients and those who are responsible for setting the standards for the residents who care for patients.”
The research was conducted by Lake Research Partners and sponsored financially by the Committee of Interns and Residents/SEIU and Public Citizen. The manuscript authors included representatives from Harvard Medical School, Mount Sinai School of Medicine, Montefiore Medical Center at Albert Einstein College of Medicine, the Committee of Interns and Residents/SEIU, and Public Citizen.