As per the rules of the Accreditation Council for Graduate Medical Education in the United States of America, residents are allowed to work a maximum of 80 hours a week averaged over a 4-week period.
[1] This process, they contend, reduces the competitive pressures on hospitals, resulting in low salaries and long, unsafe work hours.
Research from Europe and the United States on nonstandard work hours and sleep deprivation found that late-hour workers are subject to higher risks of gastrointestinal disorders, cardiovascular disease, breast cancer, miscarriage, preterm birth, and low birth weight of their newborns.
Consequently, the disruption of slow-wave sleep increases the level of amyloid-beta, a protein aggregate commonly found in Alzheimer's, present in cerebrospinal fluid the following morning.
[11] Chronic sleep deprivation and the resulting fatigue and stress can affect job productivity and the incidence of workplace accidents.
[14] A study found that after 24 hours of sustained wakefulness, hand-eye coordination decreased to a level equal to the performance observed at a blood alcohol concentration of roughly 0.10%.
[20] First year medical residents given an EKG arrhythmia-detection task performed significantly worse while sleep-deprived than when well-rested.
[19] In 2015 two controlled studies of the effect of the ACGME-mandated maximum shift began, involving nearly 190 hospitals and residency training programs.
A study led by the University of Pennsylvania, which will end in 2019, assigned residents in 32 medical training programs to shifts as long as 30 hours.
In neither study were residents and patients necessarily told they were part of a human subjects experiment and informed consent was not required, which caused some controversy.
One 2014 systematic review of 135 studies spanning 1980 to 2013 showed no overall improvement in patient safety but still indicated that duty hour restrictions have increased morbidity in some cases.
[28] Another study found that the 2003 ACGME reform restrictions were associated with a small reduction in the relative risk for death in 1,268,738 non-surgical patients drawn from a national survey of hospitals.
Second, the penalty for work hour violation is loss of accreditation, which would adversely affect medical residents and prevent them from becoming board certified.
[35] Moreover, these studies – particularly the ones that find favorable results - may fail to account for confounders that positively impact outcomes, including the wide adoption of electronic medical records, a shift toward team-based care, and implementation of best practices.
[36] Duty hour regulations may not address the root causes of medical errors, and may inadvertently create new problems that impact patient outcomes.
][42] The suit had some early success, but failed when the U.S. Congress enacted the Pension Funding Equity Act in 2004, which exempting matching programs from federal antitrust laws.
Starting in 2003, with revisions in 2011,[45] regulations from the Accreditation Council for Graduate Medical Education capped the work-week at 80 hours.
The Institute of Medicine (IOM) built upon the recommendations of the ACGME in the December 2008 report Resident Duty Hours: Enhancing Sleep, Supervision and Safety.
The ACGME officially recommended strategic napping between the hours of 10pm and 8am on 30-hour shifts for residents who are post graduate year 2 and above but did not make this a requirement for program compliance.
In 2017, the ACGME changed its regulations once again, citing a trial conducted from July 2014 to June 2015 in 117 general surgery residency programs.
[51] In the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, programs were randomly assigned to a group following current ACGME duty-hour restrictions or a group with more flexible policies that waived rules on maximum shift lengths and time off between shifts.
[4] These residents cited "additional experience" as the most common reason (69.0%), followed by "opportunity to see rare cases" (46.5%) and "continuity with patients" (31.8%).
[4] The Libby Zion case, in which an 18-year-old college student died of a drug interaction after being treated by a fatigued intern and resident in a New York hospital, led to the establishment of the Bell Commission in 1987 to address physician training hours.
[54] Though other federal regulatory and legislative attempts to limit medical resident work hours have materialized, none have attained passage.
Indian researcher Dr Edmond Fernandes, Founder of CHD Group called for regulating work hours but the same has not been implemented by the Ministry of Health and Family Welfare till date.
Requiring naps during long shifts could be a small step toward reducing fatigue and potentially decreasing errors.
Resident surveys suggest that a greater emphasis on education, decreased workload, and more ancillary support would better improve patient outcomes.
[37] Focusing on hospital best practices and physician incentives like pay-for-performance in residency could help with the implementation of some of these solutions[citation needed].