US public opinion regarding proposed limits on resident physician work hours.

Alexander B Blum,David Mermin,Sandra Shea,Peter Lurie,Charles A Czeisler,Farbod Raiszadeh,Christopher P Landrigan

doi:10.1186/1741-7015-8-33

Abstract

BackgroundIn both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue.MethodsWe conducted a national survey of 1,200 representative members of the public via random digit telephone dialing in order to describe US public opinion on resident physician work hour regulation, particularly with reference to the IOM recommendations.ResultsRespondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h) and 58.3-h work weeks (95% CI 57.3 to 59.3 h). They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h) and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h), with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%). A total of 81% (95% CI 79% to 84%) believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71%) favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with ≥5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83%) would then want a different doctor.ConclusionsThe American public overwhelmingly favors discontinuation of the 30-h shifts without protected sleep routinely worked by US resident physicians and strongly supports implementation of restrictions on resident physician work hours that are as strict, or stricter, than those proposed by the IOM. Strong support exists to restrict resident physicians' work to 16 or fewer consecutive hours, similar to current limits in New Zealand, the UK and the rest of Europe.

Highlights

In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine
On 17-22 November 2009 and on 21-30 January 2010, 1,200 members of the general American public participated in an 18-min telephone survey (Figure 1) that was conducted by an independent public opinion research firm (Lake Research Partners, Berkeley, CA, USA)
The Institute of Medicine (IOM) recommendations represent one of the first efforts to substantively reform resident work hours initiated by the leadership of academic medicine, rather than by legislative bodies

Summary

Introduction

In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. Reduction in the work hours of resident physicians (junior doctors) has been the subject of considerable controversy both in America and Europe. Under current regulations of the Accreditation Council for Graduate Medical Education (ACGME), the private body that accredits all US residency programs, resident physicians in the US work extended duration (≥24 h) shifts 1-2 times per week and work 80-88 h per week, on average. Chronic sleep loss, induced by long work weeks, and acute sleep loss, induced by extended duration work shifts, interact synergistically to severely degrade performance, especially at night [36]. A meta-analysis of studies from 959 physicians revealed that following 24 h without sleep, their clinical performance declines to the 7th percentile of their rested performance [37]

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