Some Medical Interns Still Overworked

Sept. 5, 2006 -- New doctors still often work long hours, despite rules to the contrary, and may be more accident-prone when exhausted.

Those findings are reported in JAMA, The Journal of the American Medical Association.

Doctors' training, or residency, traditionally includes working long hours. Some shifts may last more than 24 hours, although not all are that long.

In 2003, new rules went into effect for all doctors-in-training (residents) in the U.S. Those rules, issued by the Accreditation Council for Graduate Medical Education (ACGME), include:

• Residents may work up to 30 hours in a row.
• Residents may work up to 80 hours a week, averaged over four weeks.
• Residents must have 1 work-free day every 7 days.

But during the first year those rules were in effect, more than eight in 10 first-year residents, called interns, reported working more than the rules permitted, according to Christopher Landrigan, MD, MPH, of Harvard Medical School, and colleagues.

Landrigan's research was based on more than 1,200 interns who kept tabs on their work hours.

A before-and-after check of interns' hours show the rules made a difference.

Interns' average hours shrank from more than 70 weekly hours before the rules went into effect to about 66 afterwards, the study shows.

But the rules weren't always observed.

In at least one month during the study:

• Nearly 30% of interns reported working 80 or more hours weekly.
• About 12% of interns reported working 90 or more hours weekly.
• Almost 4% of interns reported working 100 or more hours weekly.

Rule violations became rarer -- but didn't stop -- as the year progressed.

Interns who worked long hours and night shifts were more likely to accidentally cut themselves or stick themselves with needles, according to another study in the journal.

The studies don't show whether overworked interns made any medical errors that affected patients.

"The public fully expects that every patient should have an awake, alert, and competent physician at all times," write the ACGME's David Leach, MD, and colleagues in a journal editorial.

For interns, "high-quality learning is impossible in the absence of high-quality patient care," the editorialists write.

"Likewise, high-quality patient care is impossible without high-quality learning," they continue. "Attention to both is needed."

SOURCES: Landrigan, C. The Journal of the American Medical Association, Sept. 6, 2006; vol 296: pp 1063-1070. Ayas, N. The Journal of the American Medical Association, Sept. 6, 2006; vol 296: pp 1055-1062. Leach, D. The Journal of the American Medical Association, Sept. 6, 2006; vol 296: pp 1132-1134. News release, JAMA/Archives.