Even if a surgeon doesn’t physically collapse on top of a person, drowsy doctors are more likely to experience lapses in memory and judgment that can prove critical. In other words, the brains of doctors are subject to the limits of physiology in much the same way as other human brains.
In this month’s issue of The Atlantic, I wrote about my experience with sleep deprivation during medical training, and since publication, I keep hearing iterations of the same response—a version of what this caller asked on a Wisconsin Public Radio show on which I was a guest yesterday: “I remember 30 years ago in a human physiology class, it seemed like there was a good understanding then of sleep cycles and how harmful it can be to mess them up. I wonder why the medical profession—the one that should understand this the best—seems to be the one that kind of abuses this the most?”
It’s an especially timely question, because right now things stand to get only more extreme for medical residents. The organization that makes the rules for medical trainees—the Accreditation Council for Graduate Medical Education (ACGME)—is proposing increasing the current number of consecutive hours that young doctors can work, from 16 hours to 28 hours.
When I was a medical intern (the first year after graduating medical school) in 2009, the limit for people in my position was 30 continuous, sleepless, busy hours. The Institute of Medicine had issued a report the year prior saying that was unsafe. At the request of Congress, the physician body had audited the ACGME rules and said that the limit for shifts should be 16 hours. (Or 30 hours with a “5-hour protected sleep period” in the middle. Which sounds meager, but there were times I would have sold my soul for even 20 minutes of sleep.)
In 2010, the ACGME changed its rules accordingly—for first-year residents, at least. Hearing that, I thought I’d be the last class to have his first-ever hospital shift be 30 hours in the ICU. That mix of panic, inadequacy, and exhaustion that I wish on no person—for the new class, that would simply be a mix of panic and inadequacy. The exhaustion from 16-hour days would be more chronic than acute.
But now the ACGME is proposing raising that limit back up to 28 hours. The group is currently accepting public comments on proposed revision, until December 19. After that, the task force will use the comments to inform final recommendations.
I asked the ACGME why this is happening. The group’s spokesperson said no one was available to talk to me for a few days, but they were happy to answer my questions in written form, which they did (and that’s why the quotes here sound stilted).
The group said the 28-hour maximum is “based on new evidence, research and expert input.” At a national meeting in March of 2016, the ACGME heard perspectives from specialty societies, certifying boards, patient-safety organizations, resident unions, and medical student organizations. Among the new evidence since 2011, the most influential study was a large survey of surgical outcomes. Published earlier this year The New England Journal of Medicine, it found that for surgical residents, “Less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications.”