1. All fifty states require at least one year of hospital work for doctors-in-training educated at medical schools in the United States. Graduates of study programs at most foreign medical schools may have to complete two or three years of residency, although there are exceptions.
2. The trainees receive supervision from medical professors and doctors called attending physicians. A report published by the Journal of General Internal Medicine shows how important preparation and supervision are during residency. David Phillips is a sociology professor with the University of California at San Diego.
3. He and his student, Gwendolyn Barker, examined more than sixty-two million death records from across the United States. These records were from nineteen seventy-nine to two thousand six.
4. The two researchers closely studied the records that listed errors involving medicines as the main cause of death. They found that these medication mistakes caused ten percent more deaths in July than in other months. They found that the increase took place only in areas with hospitals where new doctors train. There was no such increase in areas with no teaching hospitals.
5. In nineteen ninety-nine, the Institute of Medicine of the National Academies released a report about mistakes in American hospitals. The report said preventable mistakes resulted in at least forty-four thousand deaths each year.
6. Later, the New England Journal of Medicine published details of two government-financed studies about serious mistakes. The studies found that the mistake rate in two intensive-care areas decreased when interns worked fewer hours.
7. The Accreditation Council for Graduate Medical Education supervises medical education. In two thousand three, the Council reduced the hours that residents may work. It limited residents to no more than thirty hours of continuous duty. A hospital was not supposed to require more than eighty hours of duty in a week. Some residents had been spending more than one hundred hours a week at their hospitals.
8. More recently, the Institute of Medicine reported that the shorter workweek did not help residents. It said they were getting far less sleep than they should. The report said the residents were attempting to do as much work in the shorter time as they had done while working more hours. So the Institute of Medicine proposed that residents be required to get five continuous hours of rest for every sixteen hours on duty. It also asked that residents be given fewer duties and more supervision.
9. These Institute of Medicine proposals have yet to be accepted. That is because the Accreditation Council for Graduate Medical Education has not yet reacted to the report. But it is expected to do so soon.
10. Whatever the Accreditation Council decides, American public opinion about the issue appears clear. That is true, at least, of most of one thousand two hundred people who recently answered questions for a study on the issue.
11. A team led by Alex Blum of Mount Sinai School of Medicine in New York found that the public wants to limit work hours by resident doctors. The study found there is strong support for restricting work by doctors-in-training to sixteen or fewer hours at one time. The team said that would be similar to what is required in New Zealand, Britain and Europe.
12. Critics of limiting hours say such a requirement could cost American hospitals about one billion seven hundred million dollars a year. Researchers for the RAND Corporation and the University of California at Los Angeles have said that few medical errors cause injury.
13. They also said changing work rules could cause other kinds of mistakes. If resident doctors work shorter hours, the researchers said, errors could happen when one resident takes control of a patient’scare from another.
14. The New England Journal of Medicine published an editorial with that report. The writers expressed concern that the proposed changes would place too much importance on the number of hours worked. The editorial questioned whether reduced work hours could give the residents the education they will need as doctors.
15. Clearly, the hours of service required of doctors in training are disputed. Even if the hours are reduced, they are also clearly demanding. Still, uncounted people throughout the world want to be doctors. And, it does not seem that hard work will stop them.
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