IHN Database

Shorter work shifts imperative for interns

BOSTON, MASSACHUSETTS. Medical tradition and the US Accreditation Council for Graduate Medical Education sanction long work hours for interns (newly graduated medical doctors) working in hospitals. Work shifts of 30 hours or more are common and some interns report working more than 100 hours per week (out of a total 168 hours) - not leaving a lot of time for sleeping.

Researchers at Harvard Medical School have now investigated the effect of these long work hours on the likelihood of interns being involved in motor vehicle accidents. Their study involved 2737 interns who completed 17,003 monthly reports providing detailed information about work hours, documented motor vehicle crashes, near-miss incidents, and unplanned episodes of falling asleep.

The average number of extended work shifts per month was 3.9 with an average duration of 32 hours. The actual number of hours worked per shift ranged from 17 to 38. The researchers found that interns driving home after an extended work shift had twice the risk of being involved in a motor vehicle crash and 5 times the risk of having a near-miss incident when compared to interns going home from a non-extended work shift. They also noted that interns who had worked 5 or more extended shifts in a month had a significantly increased risk of falling asleep at the wheel or while stopped at a traffic light.

The implications of these findings for patient care in hospitals are obvious. The researchers estimate that interns in American hospitals worked approximately 20,000 extended shifts exceeding 40 consecutive hours each while caring for patients during the period 2002 to 2003.

Although there is no indication that the US Accreditation Council for Graduate Medical Education is about to change its position on extended work hours any time soon, legal considerations may force a change. The state of New Jersey recently enacted a law whereby killing someone in a motor vehicle accident automatically becomes a criminal homicide if the responsible driver had been without sleep for a period in excess of 24 hours. Similar legislation is pending in New York, Massachusetts, and Michigan. The practice of extended work shifts for physicians is banned within the European Union; here the maximum number of consecutive hours a physician can work is 13 hours within any 24-hour period.
Barger, LK, et al. Extended work shifts and the risk of motor vehicle crashes among interns. New England Journal of Medicine, Vol. 352, January 13, 2005, pp. 125-34

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