Reforms imposed five years ago to rein in the long work hours put in by doctors in training don't go far enough to reduce risks to both patients and sleep-deprived trainees, according to a report released Tuesday.
The report, produced by the Institute of Medicine, an arm of the National Academies, recommended that medical residents ideally should work no longer than 16 consecutive hours, considerably less than the 30-hour shifts now allowed.
If they have to go longer than 16 hours, they should be required to take a five-hour nap, which would count toward a maximum 30-hour cap.
The institute also recommended that any hours spent moonlighting should count against the maximum 80 work hours allowed per week (averaged over four weeks). That could eliminate a popular practice for residents, who make about $40,000 a year and are often burdened with large educational loans.
Dr. L. Toni Lewis, who recently completed a residency in family practice and now heads a union representing residents in five states, called the report "historic."
"We're really excited that they're focusing so much on the 16-hour work limit," she said. "And [the report] addresses not just the hours but the quality of resident education and patient care."
But others viewed the recommendations as still too weak. Dr. Peter Lurie of the consumer advocacy group Public Citizen said the mandated five-hour nap was just a ruse to make sure residents could still work a 30-hour shift.
"No one is going to get anything approaching five hours of sleep," Lurie said. "It's just an elaborate effort to keep alive the current guidelines while requiring organized medicine to make as few changes as possible."
Residents -- so called because in the late 1800s, they actually lived in hospitals -- are medical school graduates who care for patients under the supervision of experienced physicians.
A form of apprenticeship, residency has long been notorious for brutal hours and minimal pay. Residency can last three to seven years, depending on the specialization.
The move to limit those hours began in 1984 with the much-publicized death of Libby Zion shortly after she was admitted to a New York hospital. Her father, a well-known lawyer and journalist, became convinced that the 18-year-old died because the residents on duty that night were working 36-hour shifts and caring for too many patients.
