30 Something Baby Doc

Teaching hospitals have come a long way since I was a resident. 2003 marked the beginning of a new phase in graduate medical education. The Accreditation Council for Graduate Medical Education placed work restrictions limiting resident physicians to 80 hours per week averaged over 4 weeks, a maximum of 24 hours per shift with at least 1 day off per week and at least 10 hour off between shifts. Prior to this residents commonly worked over 100 hours per week and 36 to 48 hour shifts were common. Many of the shifts were accompanied with no sleep. I recall when I was a second year resident during a busy 36 hour shift, I was called to the emergency room evaluate a young woman with abdominal pain. I was seated in front of the patient taking a detailed history, my eyes became very heavy and the next thing I remembered was the patient exclaiming," doctor! doctor, are you ok, I think you fell asleep". In fact, I had unknowingly taken a 5 minute cat nap in front of the patient (I'm sure this significantly increased her confidence in my medical decision making) .

The mandate for reduced work hours came as a result of increasing concern by the general public over the safety of both patients and physicians in training. The relationship between sleep deprivation and patient safety received a great deal attention in 1984 when resident fatigue and lack of appropriate supervision by an attending physician were implicated in the death of an 18 year old girl named Libby Zion in a New York city hospital.

I still see a major problem inherent to these new regulations. Although the physicians in training have restrictions on work hours, the supervising attending physicians (myself) have no such restrictions . We still find ourselves completing 36 hour shifts quite often. Would you fly with an airlines that restricted co-pilots from working long hours but their pilots had no such restrictions, and commonly worked long shifts without rest. The latter is quite confusing to myself. Food for thought.