Reduce Medical Residents Shifts To 16-Hours To Reduce Errors, Report Suggests

A 16-hour work shift may sound like a long one, but that is the maximum number of hours medical residents should work in one day, says a new report.

The Institute of Medicine report, Resident Duty Hours, recommends doctors-in-training ideally works no longer than 16-hours, instead of the 30-hour shifts that now are common. Work hours longer than 16-hours would necessitate a five-hour nap counting toward the 30-hour cap.

The report by the arm of the National Academies, said that medical work-hour reforms imposed five years ago, did not go far enough to reduce risks to patients.

Doctors-in-training make about $40,000 a year and with student loans to pay, many take on additional hours moonlighting. The institute recommends those hours should count against the maximum 80-hour work load per week, according to the Los Angeles Times.  

They institute also suggests that the number of days off be increased.

Residents used to live in hospitals in the late 1800s, therefore their title. Known to be a brutal portion of training, residency can last from three to seven years depending on their specialty.

Public Citizen’s Dr. Peter Lurie says the five-hour nap is not adequate to get restorative sleep and a ruse to ensure residents could still work the 30-hour shifts.

"No one is going to get anything approaching five hours of sleep," Lurie said. "It's just an elaborate effort to keep alive the current guidelines while requiring organized medicine to make as few changes as possible."

Another critic is Dr. Mark Langdorf, the medical director at UC Irvine. He tells the Los Angeles Times that shorter shifts require hiring more residents and turning over patients more frequently to doctors who are unfamiliar with their history. That is where many medical errors occur, especially since most medical records are still not kept electronically.   

The Institute of Medicine report recommendations represents about $1.7 billion in additional annual costs in the hiring of more residents.

"We believe that the additional $1.7 billion a year is a necessary investment in patient safety and better healthcare outcomes," said Dr. Michael M.E. Johns, the panel's chairman and chancellor of Emory University in Atlanta. "The science clearly shows that fatigue increases the chances of errors, and residents often work long hours without rest and regular time off."  

Medical errors are costing us billions and leading to preventable deaths. HealthGrades, a leading hospital rating organization finds from 2004 through 2006 there were 238,337 preventable deaths among Medicare patients.  

That cost the program and ultimately taxpayers $8.8 billion. #