New rules for rookie doctors

    This year, when the newest crop of doctors reports for work on July 1, the rules will be a little different. Interns, also called first-year residents, will be limited to 16-hour shifts.

    When Stacy De-Lin was a resident in obstetrics in New York, she says, 27-hour shifts were the norm.

    “The other residents that I worked with, we developed a system where we would try to double-check each other’s work because we were pretty confident that at some point we would make mistakes,” she said. “We were doing surgeries late into the night. And sometimes it was hard not to fall asleep standing up.”

    The Accreditation Council for Graduate Medical Education monitors U.S. residency programs.

    “Ultimately this is a public and patient safety issue, and if the medical bodies aren’t willing to do it, I think ultimately it rests on local, state and national government,” De-Lin said.

    The accreditation council sets an 80-hour a week limit, but that’s an average. De-Lin says many new doctors still work an exhausting 120 hours some weeks.

    Lucian Leape, an adjunct health policy professor at the Harvard School of Public Health, says some veteran doctors refuse to believe that patients are at risk.

    “There have been some very good studies that show when residents have been up all night or are sleep-deprived they make more medical errors, and they are more likely to make serious errors, errors that can be harmful or fatal,” he said.

    At Temple University Health System, managers made shift changes to comply with the new rules and ensure that residents are learning on the job.

    “If you don’t have enough (attending physicians) on at night, then the educational aspect is lost. But we’ve increased our attending coverage at night and we actually do educational rounds,” says Susan Coull who oversees Temple’s residency accreditation.

    The European Union limits doctors’ hours to 48 a week. Leape says it’s time for the United States to do likewise.

    Duty hour recommendations from Leape and other health policy experts are included in the June 24 edition of the journal Nature & Science of Sleep.

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