Public favors limiting residents' hours: survey

The general public underestimates the amount of hours worked by medical residents, approves of capping resident shifts at 16 hours, and would request to see a different doctor if they learned their treating physician has been on the job for 24 hours, according to a recent survey commissioned by the Public Citizen consumer advocacy group and posted online by BMC Medicine, a division of BioMed Central, a British publisher of science, technology and medical journals.

Sidney Wolfe, director of Public Citizen's Health Research Group, said at a news conference that this was the first time the American public has been polled on this subject and their views are important because resident education is funded in a large part by $10 billion in taxpayer dollars through the CMS.

Also at the event, Helen Haskell, founder of Mothers Against Medical Error, said that having residents work long hours with little supervision is “really the Achilles' heel of our hospital system.” She added that resident education is based on “deceiving the public.”

“This is not education,” Haskell said while noting that residents who are too tired to work are also too tired to learn.

The survey included responses from 1,200 people who participated in 18-minute telephone interviews between either Nov. 17-22, 2009, or Jan. 21-30, 2010. Of those surveyed, 81% thought patients should be informed if their treating physician had been working for 24 hours and 80% then said they would want to see another doctor. Also, 68% said they favored the Institute of Medicine's recommendation that resident shifts be limited to 16 consecutive hours.

A representative of the Accreditation Council for Graduate Medical Education, which oversees residency programs, could not be reached for comment, but in a May 4 letter posted online, ACGME CEO Thomas Nasca, wrote that a duty-hour task force was finishing its work on revised standards. If the standards are endorsed by the ACGME Council of Review Committees, they will be posted online for a 45-day public comment period.

John Brockman, president the American Medical Student Association, said the survey was significant.

“No shift should be longer than 16 hours,” said Brockman, who recently completed his third year of medical school at Case Western Reserve University in Cleveland. “Now we can say we are not only standing up for what medical students want, but also for what the patients want.”

Reducing patient handoffs between physicians is often used as the justification for long resident hours, but Brockman said research shows that the errors caused by resident fatigue outweighed those that come from patient handoffs. He also noted that he has yet to receive any classroom instruction on patient handoffs. “It's something you learn on the job,” Brockman said.