Eighty-hour Workweeks! Thirty-hour Workdays! by Dick Meister

It's way past time for Congress to come to the aid of the medical residents who are among our most important providers of hospital care. The young doctors-in-training are being forced to work 80 hours a week, often as long as 30 hours in a single shift.

Congress has ample proof of the urgent need for legislative action to lessen the incredible workload of the highly exploited trainees, in part to protect patients from the possible errors of sleep-deprived residents. The proof came in a recent report Congress had requested from the widely respected Institute of Medicine because of concern over the treatment of residents and its possibly dangerous effects on patient care.

The institute found that exhaustion - and possible error - is common among the 100,000 residents in the nation's hospitals. They work as residents for three or more years after graduating from medical school in order to be certified as physicians, and are relied on heavily to ease the workload of the hospitals' staff doctors, nurses and other regular employees.

The institute's report didn't challenge the 80-hour workweek and 30-hour shifts that were established for the doctors-in-training by the national accrediting organization for residency programs five years ago, when the average workweek was 110 hours and work shifts as long as 36 hours. But the report did recommend that residents work no more than 16 hours straight.

Anyone working the maximum 30-hour shift would have to take a five-hour nap after 16 hours on duty. The report also recommends giving residents more days off and extending their time off between shifts.

Some other medical experts and activists complain that the institute's recommendations don't go far enough to insure genuine reform. They say it would be impossible, for instance, to enforce a nap requirement and that it's highly unlikely, in any case, that a resident could possibly get five hours of uninterrupted sleep in the midst of a shift. It would make more sense to simply ban any shifts longer than 16 hours.

How hospital administrators will respond to the recommendations is debatable, considering their response - or lack of it -- to previously suggested reforms.

The current regulation mandating 80-hour workweeks is widely ignored. Some administrators actually have contended that working even more hours is helpful to a doctor's education because it teaches him or her to make decisions under stress.

As Boston pediatrician Joshua M. Sharfstein noted, "Our medical establishment remains wedded to an excessively grueling, risky, and outdated system of training new physicians." He said the traditionally long hours of the young doctors-to-be might be acceptable "if there were data to support the notion that heroic work schedules are a necessary part of a physician's training. But no such data exist."

New York M.D. Abigail Zuger suggested that working such schedules might be of some educational value nevertheless - by helping trainees develop empathy for patients: "Stay awake every night for three years, tired, aching, nauseated and terrified that despite the very best intentions in the world you are about to make a terrible mistake. With any luck at all you will get a vague idea of how it must feel to be truly sick, powerless and frightened - and with any luck the lesson will stick even after it is all over."

Ideally, the 80-hour limit should be just a starting point toward the limits of 50 to 60 hours - or less -- that are common in most other industrialized nations. Whatever the limit might be, federal oversight seems necessary, as the Institute of Medicine recommends. But even more than that, there should be a firm federally-regulated limit, as there is on the working hours of airline pilots and long-haul freight truck drivers for reasons of safety.

Congress might also need to come up with funding to help hospitals meet the cost of hiring other medical workers to do some of the work now done by residents during their exceptionally long workweeks. The institute estimates that would cost $1.7 billion.

Eighty-hour workweeks, 30-hour workdays. Surely we can do better than that for the young men and women who are essential to the present and the future of our vital medical care system.