And, as other posters have pointed out, this is despite legislation limiting the number of work hours. The fact of the matter is that if you were to actually work to the letter of the law you'd be sneered at, receive poor evaluations, and patients would suffer because there'd be no one around to do the work.

Most programs argue that these hours are necessary to train surgeons since there's not only the usual cognitive side of medicine, but also the technical side of cutting, sewing, etc. That being said, 70% of the hours I put in at the hospital are BS "scut" work which could be automated, streamlined, or passed off to assistants. The actual challenging decision points are few and far between.

Thus, even the 10,000 hour rule--which a lot of programs use to defend their dismal hours--misses the mark completely since, well, the practice isn't focused.

I don't think surgeons are going to be replaced by robots in a significant way for some time, but I would like to see the hands-on part of surgery being performed by techs. A three year, well planned course would be plenty to turn you into a competent operator--as competent as many just-licensed MDs. After all, do you really need 10 years of academic training (four year undergrad, fours of medical school, two years of little operating as a junior resident) to screw bones back together? Why should we expect surgeons to be technically AND intellectually gifted?

We are expecting new duty regulations later this year in response to scientific data on fatigue and the crash of Colgan 3407. Currently the data shows that on a four-day trip we are equivalently drunk with fatigue by the afternoon of day three even with around eight hours of sleep. Most people really need about nine.

Personally, I've never intentionally flown fatigued but I have been surprised by it. By the time I notice I'm fatigued the heading indicator looks like alphanumeric soup and I cannot differentiate 030 from 300 from 330 without the utmost concentration. I tell myself to "THINK, DAMN IT", but that is futile. It is something that cannot be overcome.

Having this experience, there is no way I'd want medical attention from fatigued doctors. Sleep is important for any safety sensitive job. It's always better to error on the side of safety.

Absolute bunk. Doctors are the last people in the world who should "insist they are not affected by sleep deprivation." Their whole job is to make decisions based on medical evidence. It doesn't affect you? Prove it. Show me a study looking for correlations between medical errors and sleep deprivation. Show me a study measuring alertness at the end of an 80-hour work week. Don't give me anecdotes. Give me proof. To do otherwise, as a doctor, is hypocritical.

Here's my anecdote: my wife is a resident, and she comes home from a 30-hour shift so tired, she's nervous about driving and sometimes feels like she has the flu.

Is she just weak? Should other doctors look down on her?

Not without a rock-solid study to prove their point. Instead, doctors seem to have a hazing mentality - "I survived this, so you should have to, too." But it's really a question of medical fact: how do medical work schedules affect patient outcomes? Any doctor who doesn't see that is being dangerously irrational.

A simple test, that worked very well for me, was testing my reading speed (I know it is only a weak indicator for mental acuity, but it is easy and fast to test).

Under perfect conditions (well rested, optimal nutrition, completely silent room, no visual distractions, after mediation and a good cup of green tea) I am able to read about 800 WPM (which is not to bad) of the kind of text I usually need to read with good retention. For me this declines rapidly to less than 200 WPM (which is quite bad for a "knowledge worker") with sleep deprivation and/or a noisy environment, even though I believe I am doing fine.

That being said, even though I would say that doctors are handicapped "mental performance" is handicapped by their working conditions, I fully agree that it is better for patient safety to not hand off a patient to a new doctor say every 8 or 12 hours due to the amount implicit knowledge that a doctor gathers during a >24h time period about his patients that can't be transferred in a handoff.

Software Developers, imagine what a screw up it would be if you'd have to hand off your code every 8h to another developer, who'd have to continue right were you left... add to this not having a version control system, spotty test coverage and highly ambiguous specifications

While this may be true, the process of the handoff could be vastly improved. My wife is a resident, and the quality of info she gets during a patient handoff varies drastically, from detailed notes in a computer, correlated to medical history, to scrawled notes on paper. Sometimes she has to start from square 1.

Maybe the reason handoffs are harmful is because they're done poorly. And maybe they're done poorly because the doctor who's handing off is freaking exhausted.

It's like a guy who's driving home after a 20 hour day that ended with a couple of drinks at the bar, calling home from the car to tell the wife that he's on his way and his driving is perfectly safe. In reality, he is so impaired by the tiredness, the alcohol, and the distraction of the call that he can no longer even understand how far off his game he must be, nor judge the horrific risk he must be taking by driving in that way.

http://news.ycombinator.com/item?id=652650

Still, it's rather hard to see a way for a sleep schedule like this to be viable for most people unless it becomes the dominant way that people find their rest (which is hardly likely).

http://en.wikipedia.org/wiki/Power_nap

I don't have any personal experience with this though.

(just for kicks, if you worked 10hour days for 7 days a week that is only 70 hour work week... doctors work at least 12 hour days, and usually 16 hour days to get to the full 80 hours!)

Oh and as far as weeding out?

Most 'weeding' out happens first and second year of medical school. In my class alone about 10% of the class failed first year exams, and they were forced to repeat or retake the whole year. (which SUCKS when you just paid $37,000 for a year of school that meant nothing). Then Second year weeding happens again with STEP1 licensing exam:

"Overall pass rates for first time USMLE Step 1 test takers are: 92% for U.S. M.D. medical school graduates, 81% for U.S. D.O. osteopathic medical school graduates, and 73% for international medical school graduates" http://en.wikipedia.org/wiki/United_States_Medical_Licensing...

Fail a year or a board exams? You pretty much can only be a psychiatrist or family doctor with little or no hope of every specializing.

My SO is a medical resident. They really are placed in unstable situations (to use a math/physics term). They are required to work 80 hr/week. If they report working more than 80 hr/week they get into trouble for a duty hours violation and yelled at for being "inefficient". If they report less than 80 hr/week they get in trouble for being slackers (a.k.a. "unprofessional", actually that's a catch-all phrase for anything the speaker doesn't like). No serious thought seems to be given to increasing staff levels.

And that's the problem (not your problem but the profession's problem) - the hope is to specialize whereas being a family doctor is the booby prize.

Well I know abut family but why psych?

I know one person who dropped out, but was at married to another resident, so has a safety net. Another resident dropped out due to a medical condition that prevented him from standing for hours a day and landed a job at McKinsey. Another friend dropped out and became a receptionist! Eventually she went into a residency for a lower stress specialty (surgery -> psychiatry).

The only area that learning how to deal with sleep deprivation would be a benefit is surgery and critical care areas (ICUs). But then again, if you could schedule things better and get more doctors in, maybe these doctors don't have to learn how to function on 5 hours of sleep.

I think you're right to the extent that the current medical service system requires doctors to learn to sleep less and less while functioning on an acceptable level (note that I didn't say satisfactory or even exceptional). But I think that's begging the question. Shouldn't we be able to change the current system and allow doctors to focus on building skills/knowledge, not the ability to function without sleep.

tl;dr: sleep deprivation is not a necessary part of being a doctor if we change the system, so saying that doctors must learn how to deal with sleep deprivation is a circular argument.

http://www.npr.org/templates/story/story.php?storyId=1135711...

Frankly, I'm surprised that as many doctors make it through - the working conditions are pretty terrible. Maybe the pay makes up for it, but you only get paid well once you get out of your residency or fellowship.

Better conditions will probably produce better doctors, not subpar doctors.

EDIT: Applied s/two/too