Doctors are dangerously tired, and healthcare leaders aren’t taking action
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Do you want your surgeon to work back-to-back overnight 12-hour shifts and then perform brain surgery on you the next morning? There’s currently no regulation prohibiting this kind of dangerous scheduling in medicine.
Physicians are human. Like truck drivers or airline pilots, their fatigue can lead to dangerous consequences for those around them. A recent study showed that even mild sleep deprivation causes the same levels of impairment as alcohol intoxication. Truckers and pilots have to comply with regulations forcing them to rest, however, and physicians do not.
Medicine has not only had a long history of avoiding regulations on shift hours, but of also actively encouraging burnout-inducing work schedules, especially during medical training:
“Long and unpredictable work hours have been a staple of medical training for centuries. In fact, the term ‘resident’ is a relic of times when physicians in postgraduate training literally lived at the hospital. Though this system faded away several decades ago, as recently as 15 years ago, resident physicians routinely worked 90–100 hours per week, for up to 36 consecutive hours without rest, for the entire duration of residency training. These grueling hours were viewed by many as a necessary ‘rite of passage’ and were considered essential to ensure that physicians developed their clinical acumen and would be capable of independent practice once training was completed.” (Agency for Healthcare Quality and Research, 2017)
Residency hours were capped at a “mere” 80 hours a week under 2003 and 2011 regulations from the Accreditation Council for Graduate Medical Education. These controversial limits led to a small but measurable reduction in risk of death among patients. But the gains may be short-lived: There are widespread reports from the front lines of medical residency showing that limits are commonly violated and hours are encouraged to be underreported. A 2007 UCLA study found that 20 percent of residents said they had fallen asleep while driving because of work-related fatigue. During all this, ACGME is considering loosening rules to allow residents to work 28-hour shifts.
Long and unpredictable work hours don’t stop during medical training. Today’s average physician continues to work 59.6 hours a week. American doctors are in an epidemic of burnout, thanks to this systemic perception of rest as inefficient weakness.
In America, it is far more dangerous to be a patient in a hospital than to fly 40,000 feet in the air in an aluminum tube at 500 miles per hour as an airline customer. In the last eight years, not one person has died in a crash of a U.S.-certified commercial airline operation anywhere in the world. According to a Johns Hopkins study, more than 250,000 Americans die from preventable medical errors every year. Taking physician fatigue seriously would not fix every fatal medical error, but it would surely lead to greater patient safety.
The Federal Aviation Administration (FAA) sets strict limits for pilot rest. In 2011, the agency specified that no flight shift last longer than 8–9 hours; pilots received 10-hour mandatory rest periods and set weekly and 28-day limits on flight assignments. The FAA maintains an ongoing work group on Fatigue Risk Management and online fatigue risk assessment quizzes.
Is it time for Health and Human Services to form a similar fatigue risk program? Is efficiency- and safety-leader Kaiser Permanente already testing fatigue science policies with their staff physicians? Would the American Medical Association take up this cause for its member physicians? Someone needs to stand up for sensible, safe physician shift schedules.