Article Source: msnbc.com
from:msnbc.comProposal would shrink first-year residents shifts from 24-hours to 16
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It's well known that lack of sleep reduces information processing ability of the brain, and memory recall, and memory formation. In other words, doctors without sleep make more errors plus they don't learn from their mistakes. This tradition seems to have been a initiation of some sort. I can assume the traditional punishment phase they had put rookie doctors through was a behavioral training to make them be obedient and loyal medical profession club members over any other purpose.
The practice of forcing residents to work these abominable shifts is nothing short of hazing on the part of the older establishment and I wonder how many deaths have occurred from this frat boy practice. I used to be of the mind that young doctors had to earn their stripes but when my young child was in a childrens hospital and the resident literally fell asleep during a consultation, I really did an about face. I wonder if these older doctors are proud of the deaths caused by their pride in the hazing phase of these young doctors. Of course not though, they're too caught up in their narcissism and golf games to really care.
It's about time, and it took to long to reach this logical conclusion. It might also help the "rookies"
from becoming drug addicts by the time thy are full fledged doctors, with full fledged psychosis, from lack of sleep.
Thus reducing Medical Malpractice suits.
It's too bad that there is no data, at all, to support work hour restrictions. In fact the existing data clearly show that the exchange of patient care due to mythical hour limitations leads to worse outcomes. Humans who are trained to can work very efficiently for very long hours, particularly when they are relatively young and healthy. The stakes are exactly as high as on a battlefield when there is no timeout. The soldiers who fight those battles are able to do so due to rigorous training, BEFORE the battle. By the way, their officers who are all older than the enlisted 19 ish year olds they command lead those battles often for days on end with little sleep. Residency is that training when decision-making while tired is backed up. The quality of current trainees is not what is once was due in part to arbitrary work hour limitations. That has and will lead to worse physicians who do not know the value of really hard work and more importantly how to work hard and well when tired. This is one more nail in the coffin of the American physician. Nurses have and will be asked to do more and more of our jobs while we meekly accept myth couched as "safety". Bad form!
Bull@!$%#.
Working those types of hours have shown time and time again that mistakes happen due to sleepy people. I have worked shifts of 12 hours, they take their toll, especially toward the end of a work week. I wouldn't want some doctor at the end of his 24 hour shift operating on me and neither would you. Training people does nothing to help fight or cope with fatigue.
On top of that, who thought 24 hour shifts were a great idea? How long ago were these shifts 48 and 72? This was a stupid idea and does nothing to help train any doctor on anything.
While it is true that young people can work for longer hours and soldiers sometimes are forced to fight for days without stopping, fatigue causes all of them to make mistakes.
There was an Abrams tank driver who fell asleep and drove into the Euphrates river during second the Iraq war. I myself can recall falling asleep with my eyes wide open when I was a 17 year old Army trainee.
I'll put a well rested doc with a 12 hour work limit up against one who has for worked for 24 straight hours any day. Who do these people think they're kidding?
Having trained under the "80-hour work week" rules, I disagree with the proposed changes to shift length and patient volume. However, if these are the new guidelines for better patient care, then there should be a compensatory increase in the duration of training.
Would you want a resident, in his 50th hour, working on you? I understand your point of hours on training but how much of that is really learned? After a certain point, the brain shuts down and nothing is learned. I'd rather see fresh residents doing 10 hour days versus exhausted doctors prescribing medicine or God forbid operating. Writing a bad prescription is not a badge of honor.
Maybe it would be better to avoid teaching hospitals and get your care at a community hospital were there are no tired doctors around at night -in fact there are no doctors in house at all at night.
It is outrageous that severely sleep deprived doctors are allowed to treat patients. How did this ridiculous tradition get started?
I'm glad first year residents will have their shifts reduced to 16 hours, but still, how does that give them 8 hours to sleep? They still need to commute, shower, eat, and have a little personal time. There's no way they will get 8 hours sleep.
And why will 2nd year residents still have the 24 hour shifts? Do their bodies and brains magically change to be able to handle that after the 1st year?
How does this solve anything? Its just shifting the workload. Now instead of sleep deprived residents we will have sleep deprived attendings. Its safer to have a fresh 60 yr old attending supervising a sleepy, inexperienced resident than a sleepy 60 yr old supervising a fresh, but inexperienced resident.
Sigh, they are probably going to extend the length of residency leaving us in debt traps until we are in our 40s. How will we save for our kids' college and retirement?
yes, we must urgently do something about the growing problem of impoverished doctors.
and yes, that is sarcastic.
Um, really? Are you serious? How about living within your means, or even below them while you do your residency. Depending on the state, residents earn a salary of anywhere from 30k - 40k so it's not like they work for free. Many families survive and save for college for their kids on such a salary. You just have to live like a regular person. Instead of having that Porsche or BMW, get something less flashy but far more economical; and maybe start with a simple 3 bdrm house instead of the 5 bdrm house w/pool.
And I know what I'm talking about having worked in healthcare for 20 years, I've heard the residents talk about what new cool toy they just bought.
Ironic too that no one I know of who works in a hospital will let a resident work on them, we all know better.
I can't agree more that resident hand-offs are more detrimental to patient care and outcomes than the current 24 hour restrictions, and the proposed changes will lead to a significant increase in these hand-offs! Not to mention than this will undoubtedly drive up health-care costs even more as programs have to be expanded and lengthened to accomidate these new rules. I hope that there is enough outcry to kill this proposal or at least know it down to a more reasonable restriction!
And everyone is for off shore drilling as well. So if the process is broke, why not change it?
And the health care costs may increase but the malpractice costs will certainly decrease. Maybe a decrease in malpractice insurance rates will actually attract students to consider medicine versus the ever declining enrollment in medical schools.
Where do you get your data regarding declining medical school enrollment? Because according to the AAMC, in 2008 (last year data available), there were just under 43,000 applicants for just under 18,000 positions (http://www.aamc.org/data/facts/charts1982to2007.pdf). As the chart shows, the current matriculation rate is the highest ever. Not exactly declining enrollment, and definitely no shortage of applicants.
The reality is, the fewer hours residents are allowed to work translates into increased costs as a whole through an increase in the number of residents required to complete the same amount of work, a decrease in resident quality of life due to more consecutive, albeit shorter shifts, and as Michael Williams above pointed out, there is little data to show that the recently imposed work hour restrictions, first to 36 consecutive, then 30, and now 24 consecutive hours has made any difference in the number of medical errors. Any expectation of realized gains though reductions in malpractice claims is an exaggeration.
The length of training will no doubt increase as there simply will not be enough time to have adequacy of experience if work hours continue to have tighter restrictions. While some may argue that financially doctors will be just fine, one must consider that it often takes 20-30 years to pay off the burdensome educational loans. During their training period of between 3 to 9 years depending on specialty, picture a resident making about $52,000, closer to 35k or 40k after taxes, paying ~$1,000-2,000 per month just for loans. That leaves a take home salary of between 11,000 to 28,000 per year for many who have families to support. Is that ridiculous for someone who works 80 hours a week after 8 years of higher education? You tell me. Its equivalent to a job paying slightly above minimum wage in most states. Any further restrictions on work hours are overzealous and will not improve quality of care.
remember back in the day as RN in med ctr ,,,,Those were gruesome hrs and shifts for residents........yet it built docs to handle evey situation anytime under all circumstane....really seemed cruel especially first year but it made you there and problem solving for all anytime as situations occured....limits might limit interesting on going managemenbt of complex cases...might not be so good
It's about time that these long shifts that are put on new docs is being addressed. I've seen some crazy blunders over the years that were caught early by unit secretaries and RN's.
Case in point, an "incorrect dosage" was caught by a unit secretary and, to her credit, she turned it into a little "hospital humor". The resident wrote the orders and began to walk out. The secretary called him back and told him that he forgot to write ventilator orders for the patient. The resident replied that this patient wasn't on a ventilator and the secretary's reply was no, not now but he will be after this 50mg of morphine is given. Fortunately, the resident had a sense of humor and hopefully learned to be more careful.
No RN would have given such a dosage but this is just one benign story of many benign and not so benign. I could go on. Adequate sleep just makes sense.
I've never understood the benefit(s) of those shift hours. Even 16 hour shifts do not allow the resident/intern to receive the medically recommended 7 - 9 hours of sleep [not rest, but sleep]. I want the rested medical professional, just as I want the rested airline crew.
Do soldiers in combat get the medically recommendeed 7-9 hours of sleep..Ever been or exposed to ER medicine in an inner city medical center in the heat of August ....Best to learn under dire conditions ...and get training that way...Is there reasearch to show if doctors long term who trained under grueeling residencies vs less intensive conditions have better outcomes with their practice and better patient outcome ???? HMMMMM
Whoever thinks that these long work hours are a form of hazing is misinformed. Do you really believe that physicians are so evil as to make people work their butts off for such a stupid reason? It is irritating to read posts from people that assume ridiculous things and decide to become an expert about something in which they know nothing. The most important thing when training in anything is putting in well-supervised hours. There is always work that needs to be done, and shortening shifts for interns without an increased workforce shifts the minutiae work to the more senior staff and doesn't allow them to focus on the bigger picture, including training the interns. I would rather have a tired intern taking care of me, than a tired chief/attending, because they are truly the final line of safety when it comes down to it. However, the best of both worlds would be to have all caregivers be awake. In order to accommodate the need for training hours and the need for reduced resident working hours, there should be an increase in the number of staff within an institution as well as an increase in the length of training in order to obtain those supervised hours. Just shortening hours will not cut it. All this takes money and accreditation from the RRC/ACGME, which won't be easy, but if it needs to be done then it needs to be done. I am all for shorter working shifts and improved working conditions, and the things you get to experience while in residency may never be replicated so the increased residency duration may not be so bad.
I think the key is in regulating any sort of change. It is hard to change the 'status quo' inside the hospitals. The modus operandi is "If I did it, you will do it." The way things are done now are bull****. The regulations say that residents can work for 24 hours at a time with "up to 6 hours to transfer care on to the next doctors." Ok that is just baloney, it is a 30 hour shift any way you look at it. I would jump for joy if it was only 24 hours, but no it is really 30 hours in disguise. And it doesn't end there! When you are on call it is really a 30 hour minimum because you are 'guilted' into fixing any problems that are not finished by the time your 30 hours are up... dont forget the 'mandantory lectures' that you just can't miss after you have been up for 30 hours straight (as if you will be really learning anything as you are falling asleep) The "5 hour nap" that the author of the article talks about for interns in one hospital is a dream...something like that would be quite a golden rarity in the world of a resident. The first day I started I worked 28 days in a row (I thought I was supposed to get at least 1 day off per week or 2 days off every 2 weeks!!). When I asked my superiors about this policy they said "You don't get it, this is the CCU!" Sounds like bad policy to me. No one will speak up because they are afraid of getting in trouble or labelled a 'trouble maker. Worse if you become a whistleblower and tell the authorities about your hospital, the resident program could be shut down! (you lose your job plus all the years you worked as a resident could be lost) Thats why no one will complain.
Plus the only reason I actually got a day off after working 28 days straight is that I had caught some illness from a patient and was violently ill (with no sleep to fight it off). For the first time ever in my life I went to the emergency room and was admitted to the hospital with a white cell count of 34. (for you non medical types this is really high, 6-9 might be normal, 12-14 if you are "sick") I took 4 days off in the hospital (as a patient) at that time. When I got out of the hospital the next day I had to move out of my apartment (lease ended, despite being told to rest when I got home...when else would i have time to move out??) and I went back to work on a saterday to relieve my peers. You would think that the attending doctor might have an ounce of compassion when he approached me the next time he saw me. He told me "You know...everyone had to work really hard while you were gone, your going to have to pick it up!" This was no joke, he was serious. It made me so angry that you cant tell off "the mighty attending" no matter how cold and heartless they are!
I hope that after reading this story, all true, no embelishments, that you will support resident hour limit reform. (REAL hour limits!)
I am not afraid of working hard but you shouldn't have to work until you are sleep deprived or physically ill. There should be a strict hour limit without any baloney time to "transfer care to the next doctors" Having such a variable amount of time in that statement will mean that there is no time limit at all. Properly staff the hospital and you won't need an extra 6 hours "to transfer care" after your 24 hour shift. An hour at most is needed to have a small meeting and tell your peers whats going on.
I'm glad hours will be cut down to 16, but not enough! It should be maximum of 8 hrs with decent pay for such a stressful occupation. Are they not protected by the Labour Law?
I don't have anyone as a doctor in my family so far. But I think it is an abusive system for the residents (or any people) to work over 10 hours a day for more than a month, yet with a close to mimium pay. I have heard many of them have to rely on sleep drugs in addtion to several mugs of coffee. They are being abused and tortured by the illy-designed med system. Are they not human beings but robots? Even robots need time off for maintainence. Don't blaim their sleepy heads for hospital mistakes. The current system should be blamed and must reform. I wonder if long-working hrs may shorten their life spans or even cost their lives. Does anybody know any research on this?
Cutting down to 16 hrs? Better move but not enough! It should be 8 if longer than one month and with a decent pay.
I don't have anyone in the family as a doctor so far. But I think it's abusive for our your doctors (or any people) to work over 10 hrs for longer than a month with a close to minimum compensation! Are they not proteced by the labour law?
I have heard that some of these young fellows have to rely on sleep drugs in addition to several mugs of coffee. Don't blame them for their sleepy heads for the mistakes! The illy-designed med systems should be blamed and reform should come into effect ASAP. I think those young residents are being tortured in their personality in addition to their physical and mental health during their golden time of life. This may shorten their life span in a long run. Does anyone know any research on this?
As a someone who trains family physicians for a living, it's nice to see so much concern expressed for residents during training. Yes, we can mandate 8 hour work shifts, naps during call and hold their hands every step of the way. What do you think will happen when they graduate? There is no one watching over my work hours, or making sure that I am well rested all the time. I learned to handle the pressure of the real world through my experiences in residency. My residents are incredibly well supported, and usually work fewer hours than their faculty. Sign me up for that.
While I favor certain aspects of the new requirements, I worry that my graduates will be less competent and able to hande the stress of independent practice. Three years will no longer be enough time to train them. Who is going to pay for those extra years of training, Medicare? Primary care is already in serious trouble in this country as there are not enough of us to do the job. Now, there may be even fewer well-trained family docs. Good luck finding a personal physician if things continue to go this way.