The public wants resident physicians to work less

by Emily P. Walker

A majority of the American public doesn’t approve of doctors working 24 hours straight and supports tougher work hour regulation for resident physicians, according to a new public opinion survey.

The survey, published in the online journal BMC Medicine, is the first to assess the public’s perceptions about the controversial issue of medical residents’ work hours.

The survey found that 90% of Americans believe the maximum shift duration should be 16 hours. Current standards allow for 30-hour shifts up to two times a week.

A landmark report by the Institute of Medicine in 2008 concluded that residents should work no more than 16 hours straight. The recommendations haven’t been enforced because the Accreditation Council for Graduate Medical Education (ACGME) has yet to respond to the report, but it’s expected to do so at the end of the month.

While the issue of resident work hours has been hotly debated in the past couple years — with one side pointing to the dangers that fatigued residents pose, such as medical errors, and the other side highlighting the high costs of slashing work hours — the public’s perception on the issue is largely unknown, the study authors say.

In order to gauge public opinion on the issue, researchers from an independent research firm performed 18-minute telephone interviews with 1,200 representative members of the public by randomly dialing landline telephone numbers in November 2009 and January 2010. The participants were asked questions about demographics, medical service use, their views on resident physician work hours and on the IOM recommendations.

Most individuals surveyed (85%) said they felt residents should work no more than 12 consecutive hours, and 86% responded that physicians should work fewer than 80 hours per week.

The “stark discrepancy” between what the public wants and how many hours residents actually work is a cause for concern, said the study authors, led by Alexander Blum, MD, of the Department of Health and Evidence Policy at the Mount Sinai School of Medicine in New York City.

More than four in five survey respondents believed that patients should be informed if the doctor treating them has been working for more than 24 hours, and a similar number of people said they’d request care from another physician if they knew their doctor had been working for so long with no sleep.

“Most resident physicians routinely work shifts exceeding those that the public believes to be safe [and] there is considerable evidence that the public’s concerns regarding the patient safety consequences of extended duration shifts and provider sleep deprivation are justified,” the authors wrote.

Half of all hospitalized patients receive medical care from 108,000 resident doctors at teaching hospitals, said one of the authors of the study, Charles Czeisler, MD, professor of sleep medicine at the Harvard School of Medicine.

“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 during a Tuesday press teleconference to discuss the new survey.

“Working for 24 hours without sleep impairs performance to a degree that is comparable to being legally drunk,” he said. “Patients have a right to be concerned for their safety when doctors work marathon 24-hour shifts.”

Among the survey’s other findings:

* Three-quarters of respondents supported the IOM’s recommendations of 16 hour shifts or the alternative recommendation that residents have an uninterrupted five-hour nap during each 30-hour shift.
* Two-thirds preferred capping shifts at 16 hours over the 30 hour with nap proposal.
* A similar proportion of respondents support the IOM proposal that hospitals should be required to provide safe transportation home for residents who are too tired after their shift to get home safely.

The authors point out that their survey is limited by a low response rate of 56%. Of the more than 2,000 individuals who were determined to be qualified to respond to the survey, just 1,200 completed the interview.

In February, Public Citizen called on the Accreditation Council for Graduate Medical Education (ACGME) to stop dragging its heels in responding to the IOM report, which recommended, among other things, that residents take a five-hour nap for every 16 hour shift.

The ACGME convened a task force more than 18 months ago to draft duty hour standards and has heard testimony on fatigue, patient safety, and legal aspects of the duty hour standard. The association plans on issuing its recommendations on resident work hours in late June, according to a letter from Thomas Nasca, MD, CEO of ACGME, posted on the association’s website.

In 2003, ACGME capped the number of hours a resident could work each week at 80, but the IOM report concluded the rule change wasn’t effective because residents were trying to cram the same amount of work into a shorter amount of time.

Opponents of placing further restrictions on work hours and habits say the cost is too high: The authors of the IOM report say making the recommended changes would cost $1.7 billion annually, largely from hiring new staff or shifting the workload to other healthcare professionals.

Emily P. Walker is a MedPage Today Washington Correspondent.

Originally published in MedPage Today. Visit for more practice management news.