CIR Testifies at MA State House Hearing on Regulating Resident Work Hours

In an effort to make Massachusetts only the second state in the nation to regulate resident work hours, an internationally recognized sleep scientist and five CIR and AMSA members gathered at a State House hearing on November 3, 2009 in favor of Senate Bill 845, the Safe Work Hours for Physicians in Training and Protection of Patients Act.

The proposed legislation, sponsored by State Sen. Richard Moore, would direct the state Department of Public Health (DPH) to begin the process of regulating the number of hours that resident physicians in Massachusetts are scheduled to work. It calls on DPH to convene an advisory council of stakeholders, including the hospital industry, medical educators, residents, sleep scientists, and consumers. The advisory council would then make recommendations to DPH as it develops evidence-based regulation, including enforcement mechanisms and penalties.

Charles Czeisler, PhD, MD, gave members of the Joint Committee on Public Health a crash course in sleep science and the considerable evidence linking the extended shifts that resident physicians routinely work with increases in preventable medical errors. “In a nationwide survey of 2,737 resident physicians, our group [Sleep Medicine Division, Brigham and Women’s Hospital] found that one out of five first-year residents reported making a fatigue-related mistake that injured a patient,” Dr. Czeisler reported, “and one out of 20 first-year residents reported making a mistake that resulted in the death of a patient.”

“There are also enormous implications for resident physicians themselves,” testified Dr. Jessica Eng, a third-year Internal Medicine resident and co-president of the Boston Medical Center CIR chapter. She pointed to “an increased risk of depression, of needlesticks and subsequent exposure to HIV and Hepatitis C, and an increased risk of car crashes, which also endangers the driving public.”

Dr. Eng described to committee members the grueling 30-hour shifts that are currently permitted by the Accreditation Council for Graduate Medical Education (ACGME) and referenced the 2008 Institute of Medicine recommendation that on-call shifts be limited to no more than 16 consecutive hours.

“Given [the ACGME’s] reluctance to reduce resident hours and the fierceness with which its constituents – hospitals and program directors – are objecting to the IOM report, we have no confidence that change will occur without a bill like S. 845,” Dr. Eng said.

That resistance was evident in the testimony given against the bill. A representative from the Council of Boston Teaching Hospitals testified that the ACGME was “taking a thoughtful, comprehensive approach to the IOM recommendations” and was “in the best position to monitor resident hours.”

Dr. Debra Weinstein, Vice President for Graduate Medical Education at Partners HealthCare System and a member of the ACGME Board of Directors said that ACGME oversight was effective, citing as an example the fact that the general surgery program at Massachusetts General Hospital (a Partners hospital) was now on probation for duty hours violations. Dr. Kevin James, a resident at Tufts Medical Center spoke “in strong support of the current hours,” and Dr. Alex Ding, chair of the Massachusetts Medical Society Resident Fellow Section warned against the unintended consequences of reducing hours, citing “a de-emphasis of the professional ethos and too many hand-offs.”

But in his testimony, AMSA Health Justice Fellow Dan Henderson, currently at the University of Connecticut  School of Medicine, affirmed to committee members that “it is the duty of all doctors to practice within the known limits of safety, and that means recognizing the evidence that there is a direct connection between fatigue and error.”

More On This Story:
Operating over the limit An Op-Ed in The Boston Globe By Dr. Charles Czeisler  |  November 19, 2009
NO ONE CAN operate safely on patients after three days without sleep. Yet, for decades, surgical residents routinely worked 120 hours per week and for more than 80 consecutive hours at least one weekend per month (from 6 a.m. Friday through Monday afternoon). Then, six years ago, facing the threat of federal legislation to limit resident work hours, the profession’s accrediting council set the maximum shift length at 30 consecutive hours, though still allowing resident physicians to work 120 hours in any given week and for up to 26 consecutive days, so long as they average 80-88 hours per week and receive four days off each month.

It was disappointing to learn this week that, despite repeated assurances of compliance, the surgical training program at the Massachusetts General Hospital was put on probation for continuing to violate the 2003 work-hour limits. The surgeons who honestly reported the hours the hospital required them to work are courageous to have put patient safety ahead of job security. They well know that Johns Hopkins banished a resident physician who did the same thing; fortunately, Ohio State allowed him to finish training there. Their courage in the face of strident faculty opposition to work-hour reform is a refreshing respite from the systematic falsification of resident physician work hours that has occurred nationally since the limits were implemented. Yet, the unfortunate fact is that the grueling work-hour limits currently in place are woefully inadequate.

Read the whole Op-Ed on Boston.com