Young doctors in their first year out of medical school regularly toil beyond highly publicized new limits on their working hours, according to newly published results from a Web-based survey. The work limits, which went into effect three years ago, were meant to address the concern that hospitals overburdened these physicians in training, or residency, thereby putting patients at risk of serious medical errors. Another survey finds that the extended hours made first-year residents more likely to jab or cut themselves with a needle or scalpel.
Working 80 to 100 hours a week or even more was long considered normal for residents, on the grounds that such training taught them to operate under stress and provide complete patient care. Of course, grueling hours also double a resident's chance of getting into a car crash and make them one third more likely to commit a serious error, studies had found. In June 2003, prompted by proposed legislation to restrict residents' hours, the Accreditation Council for Graduate Medical Education began limiting residents to 30 consecutive hours and 80 hours a week, averaged over four weeks.
Those caps were routinely violated in the ensuing year, according to a report in the September 6 Journal of the American Medical Association. Between July 2002 and May 2004, more than 4,000 participating interns from all specialties filled out monthly online work- and sleep-hour logs. Of those surveyed after the new rules took hold, 84 percent reported one or more violations after the new limits went into effect; 67 percent worked more than 30 hours consecutively at least once, and 43 percent exceeded 80 hours per week, averaged over four weeks. Around half of all monthly logs reported a violation. "Across specialties and across the country the rate of compliance has been extremely poor," says the study's lead author Christopher Landrigan, a sleep and patient safety researcher at Brigham and Women's Hospital at Harvard.
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Moreover, the new work limits still leave interns at risk. A second survey found that interns were 61 percent more likely to cut or jab themselves while working 20-plus-hour shifts, with injuries occurring after an average of 29 hours. Medical culture works against the limits, explains Daniel Vo, a pediatrics intern at New York Presbyterian-Hospital/Columbia University Medical Center. After a long shift, he says, "it feels like you either haven't finished all you need to do for the patients, or you're dumping the rest of your work on your teammates."