Without a doubt, medical residents work very long hours. Most people would be alarmed to learn that the doctor treating them had been working for thirty-six hours straight or had already worked 100 hours that week. Recent studies confirm the common sense notion that sleep deprivation impairs mental functioning. In October 2004, The New England Journal of Medicine (NEJM) released a series of studies indicating that medical interns working fewer than eighty hours per week experienced less than half the rate of attention failures as those working more hours per week. The studies also found that residents working seventy-seven to eighty-one hours a week and up to thirty-six hours straight made 35.9% more medical errors than those working sixty-three hours a week and less than sixteen consecutive hours.
Given the empirical findings linking long working hours to an increased risk of medical errors, it might seem appropriate to regulate the number of hours residents can work. The Patient and Physician Safety and Protection Act of 2001 (PPSPA), reintroduced in 2005, is a bill designed to achieve this purpose. If enacted, the PPSPA would restrict resident working hours to eighty hours per week, limit shifts to twenty-four consecutive hours (twelve for emergency room shifts), and provide specific time-off requirements.
While the provisions of the PPSPA might seem reasonable or even desirable at first glance, the bill should not be passed for several reasons. As a preliminary matter, the PPSPA’s drafters and its proponents assume that capping resident working hours is inherently desirable without carefully considering the associated risks and consequences. Reducing hours may help decrease fatigue-related attentional failures, but doing so may create other serious problems, such as discontinuity of patient care. Having the resident physician involved with the treatment of a specific patient from start to finish is crucial, not only to the resident’s education, but also to the patient’s welfare. When the resident is required to stop working after a specified period of time, the patient’s file is handed off to another physician who is typically less familiar with the case. In addition, medical professionals express concern that rigid work hour restrictions could exacerbate preexisting staff shortages. . . .