Will Your Doctor Get More Reasonable Hours?

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Making rounds at the University of Pennsylvania hospital

Remember your first day of work? You were nervous, trying to make a good impression, processing endless streams of information. Happily, that day ended at about six o'clock, and you were released back into a familiar, and, one hopes, less stressful realm of sleeping, eating and socializing.

Now imagine your first day didn't end until six the following night — a full 33 hours after it began. When you did finally stumble out of the office and into your car, chances are good that your brain would be addled, your reaction times slowed and your perceptions numbed. Feel like scrubbing in for major surgery?

Probably not. But that's the sort of schedule endured every day by countless medical residents (doctors in their first years out of medical school). Starting with the intern year, new doctors spend an average 105 hours a week on the job, a timetable that leaves physicians totally exhausted — and patients vulnerable to unintentional medical mistakes.

Now, residents' legendary 100+-hour workweek may be on its way out. After years of loud but unproductive controversy, the American Medical Association will finally address the issue of residents’ hours this week at the group's annual conference in Chicago.

The grueling schedule has been the source of countless heated debates over the years; if it does go by the wayside, it won’t be without a few more shouting matches.

The battle lines are well-defined: Some doctors insist the long hours are a necessary trial by fire that produces highly skilled, virtually unflappable physicians. That point of view is fostered by a sort of hazing mentality most often seen in fraternities and the military ("I went through hell to get here, and I'll be damned if you're going to get through this without experiencing exactly the same hell.").

Others, including a growing number of residents' organizations and psychological and sleep disorder specialists, maintain residents' combat-style training is an outdated relic that leaves new doctors burned out, incapable of making rational decisions and more likely to make deadly mistakes. Earlier this year, a group of residents' advocates submitted a plea to the Occupational Safety and Health Administration, arguing that current residents' hours are a direct threat to new doctor'’ well-being. ''Any system allowing its workers to be subjected to such direct threats to their well-being is seriously flawed," the group wrote, adding that studies show residents' hours increases their risk for car accidents and major depression.

Back in the nation's hospitals, of course, it's business as usual. Even as the AMA prepares to debate the fate of the 36-hour day, residents around the country are driving to work, mentally preparing themselves for a day, a night and another day of life-and-death decisions. And all the while, most of them are using their hard-won medical knowledge not only to save lives — but also to puzzle out a way of ingesting caffeine via discreet intravenous tubing.