Blog | Friday, February 10, 2017

Are we killing our young doctors?

On the first morning of my third year of medical school, I put on my short white coat and walked onto the OB/GYN ward with a combination of terror and excitement. A few weeks later I was driving up Lake Shore Drive in rumpled scrubs. I had been on call for about a day and a half, and I remember driving north past the Fullerton exit. The next thing I remembered was waking up as my car came to a halt against the cement median dividers, the driver's side a scraped-up mess, the axle cracked, the car un-drivable.

I was lucky to walk away from my sleep-driving accident, an event all too common for medical trainees. In the years that followed, medical residents came under new rules that limited the number of hours they could work without rest. These restrictions were often flouted by dedicated young doctors who didn't want to leave their patients, or leave work for their colleagues.

It's no secret that medical training is brutal. Medical trainees are not only learning, but they are often the primary medical workforce for many hospitals. Patients may see their “real” doctor only rarely, but they see their nurses, residents and medical students several times a day.

Not surprisingly, there is a toll exacted by this kind of work. For years after finishing my residency, I still woke up at night with the sound of ventilator alarms in my head. I was sure I could feel my pager vibrating, whether or not I even had it on. It turns out I wasn't alone. Not only do doctors-in-training hallucinate the sounds and vibrations of their cell phones, they also have high rates of depression and suicidal thoughts.

Late last year, the Accreditation Council for Graduate Medical Education (ACGME) proposed increasing the number of hours trainees are allowed to work. First-year residents had been limited to 16-hour shifts. The new proposal would increase that to 24 hours of uninterrupted work time. That's more than twice as long as truck drivers are allowed to work.

Medical trainees are tasked with the incredibly complex task of caring for our loved ones in the hospital. It's not unusual for them to be caring for over a dozen severely ill patients at a time. They're driving a dozen trucks without enough sleep to keep them from hallucinating.

In February, the ACGME is planning on making a final decision on the increase in resident work hours. This is a decision that will affect every patient in the hospital, every future doctor and every driver who shares the road with them.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.