What Could Possibly Go Wrong When Doctors Are Forced to Work 28-Hour Shifts?

When my daughter did her “time” – at Stanford Medical School – I was outraged.  Being her mom, it worried me to see her work 14-16 hour shifts, and then go home to study for 4-5 hours, and then get up a few hours later to start again.  This became her norm because she might not get a day off for 2 weeks. In hindsight, they were going easy on her because the American Medical Association (AMA) supposedly protects medical students from being abused.  Medical students get holidays off, but not medical residents.  
 
Nicole finished med school back in 2013 and started her 4-year emergency medicine residency at Harbor-UCLA that same year. She was thrilled to work with the best emergency docs in the country where she had the opportunity to work with diverse and high-risk patients.  A typical shift for residents is 10-30 hours and shifts rotated from day, swing, to night at random.  She often worked 6 days in a row without a break, and even when she had a day off, she often covered for other residents who had family emergencies. Today, first-year residents cannot work more than 16 hours per shift.  SIXTEEN hours!  That is outrageous! By law, other employees can’t work more than 8 hours without getting overtime.  The Federal Aviation Administration (FAA) requires airline pilots have to log in 8 hours of sleep before being allowed to fly commercial planes, and they’re allowed to fly a maximum of 8 hours per shift. So in what universe does anyone think that it’s a good idea to have doctors making life and death decisions during a 16-hour shift? 
 
But 16-hour shifts will soon be "the good old days", because now first-year residents will be allowed to work 24 hours (sometimes 28 for transitions between shifts) per shift without a break. Seriously? Second-, third-, and fourth-year residents already work 16-30 hour shifts.  The Accreditation Council for Graduate Medical Education (ACGME) made this executive decision that will take effect  on July 1st of this year.  They claim that residents need to see a patient through from the beginning to the end, and that patients want to know that their doctor is taking care of them.  Really? If I needed to be in the hospital for 24 – or let’s say 36 hours, I would want her to go home after 8 hours to get some down time and sleep so I could see her again during her next shift when she’s at the top of her game. I’d much rather have 3 or 4 alert and conscious doctors taking care of me than a doctor who is delirious with sleep deprivation. 
 
Dr. Michael Carome, director of Public Citizen’s Health Research Group, says “Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients, and the public.” This cruel and antiquated system is really hazing at its worst.  Many established doctors feel that because they went through it, all new doctors should go through it too. 
As an educator, I recommend that students get 8-9 hours of sleep per night in order to be able to learn and retain information.  Sleep deprivation alters everyone’s conscientiousness.  This is not a new revelation so why would an important institution demand such ridiculous hours?  
 
A few years ago, I called the California Labor Commission to inquire about the 16-hour shifts, lack of breaks, no overtime pay, and maximum number of consecutive work days. I fully expected to expose the labor abuse in medical residency programs and was happy to be the whistle blower.  But, I was appalled to find that the ACGME found loopholes making it legal for hospitals to demand 16-hour shifts without paying overtime, to not give breaks, to not give regular “weekends” or days off. 
 
Here is a link to a review of the studies reflecting the impact of duty hours on just resident driving safety (not including burn-out, quality of life, or patient safety).  It includes reaction times, falling asleep at the wheel, and motor vehicle accidents. With scientific research proving that there are more accidents, mistakes, and deaths caused by residents who work more than 12 hours per shift, I would like to see the ACGME set resident work schedules to protect the patients and residents, just like the FAA regulates pilots’ flight schedules to protect their passengers.