Americans underestimate resident doctors' work hours, poll says

Most Americans believe residents -- doctors in training who work at teaching hospitals -- put in far fewer hours than they actually do, a new survey has found. And people also told the pollsters they would want to know if the doctor treating them has been on the job for 24 hours so they could ask for a different caregiver.

Dr. Charles Czeisler of Brigham and Women's Hospital and his colleagues report today on a telephone survey that asked people how many hours they thought resident physicians worked in a single shift and over the course of a week. Most of the 1,200 respondents thought the residents, who have graduated from medical school and are training in hospitals, worked no more than 12-hour shifts and no more than 80 hours a week. In reality, resident physicians are allowed to work up to 30 consecutive hours, twice a week, under guidelines set by the Accreditation Council on Graduate Medical Education. Residents are also limited to working an average of 80 hours a week over four weeks, according to the rules, but the hours any one week could be higher. The study appears in in the online journal BMC Medicine.

The guidelines were adopted in 2003 in response to research linking residents' fatigue to medical errors. Compliance was slow at first at many hospitals, including Massachusetts General Hospital. The Harvard-affiliated hospital now conforms to the rules.

A more recent report from the Institute of Medicine urged teaching hospitals to further limit residents' shifts to either no more than 16 straight hours or no more 30 straight hours as long as they included five hours of "protected" sleep free from interruption.

In today's survey, four out of five people polled said they thought cutting residents' work hours would help reduce medical errors. A similar proportion said patients should be informed that their doctor had been awake for 24 hours and given the opportunity to choose another caregiver. The margin of error was plus or minus 2.8 percentage points.

"Our findings show the American public is in sync with a growing body of scientific evidence that has accumulated over the past decade linking acute and chronic sleep deprivation with a whole range of impairments, including attentional failures, degradation in clinical performance, and increased risk of preventable medical errors," Czeisler, who specializes in sleep medicine, said today in a conference call with reporters. "After 24 hours of wakefulness, the brain is so sluggish that the average response time is tripled."

The head of an organization representing 14 Boston-area academic medical centers said he was not surprised by the survey's findings.

"There appears to be a disconnect between people's perceptions and reality," John Erwin, executive director of the Conference of Boston Teaching Hospitals, said in an interview. "I think most people's only knowledge of the physician training process is probably from 'ER' or 'Grey's Anatomy.' I was surprised that the researchers were surprised by this."

Erwin said shortening residents' hours will increase the number of times a patient's care is handed off to a new caregiver, increasing the potential for miscommunication. "The more shifts you have, the greater number of patient transfers you have, and and that's where medical errors and other patient safety issues can come in."

Erwin also was not surprised that the poll respondents said they might want a new doctor, when asked hypothetically what they might do, but he thought people would be unlikely to ask for such a change during an emergency, for example.

The national accrediting organization is weighing the Institute of Medicine's call for stricter regulations, Dr. Thomas J. Nasca, the group's chief executive officer, said in a statement.

"Later this month, ACGME will announce proposed new standards that will build on the recommendations of the Institute of Medicine and reflect the best thinking of the entire medical profession," he said. "ACGME has followed this very careful, very deliberate and thorough process to make sure the revised standards promote high-quality medical education and safe patient care."