"I'm so tired, I haven't slept a wink"

Residents work the night shift, and the day shift, and the night shift again. Is it time to trash the 120-hour work week?

Giancarlo La Giorgia

"When I signed up to do medicine, I knew that residency was going to be a stressful and challenging time and that it's part of my training," says Dr Hasan Zaidi, surprisingly upbeat for someone who's only slept three hours in the past day and a half.

It's eight in the morning and the internal medicine resident has just ended his week with a 24-hour shift at the Ottawa Hospital. But instead of getting some shut-eye, Dr Zaidi — president of the Canadian Association of Interns and Residents (CAIR) — has been doing one media interview after another, trying to play down concerns that residents work too much. Journalists have been eager to talk to him since a study appeared in the latest Canadian Medical Association Journal contending that residents are working dangerously long hours and that it's putting patients at risk.

In the study, Dr Christopher Parshuram, a critical-care specialist at the Toronto Hospital for Sick Children, measured the workload and the level of fatigue and physical stress of 11 senior residents during 35 shifts in the critical-care unit. The residents worked anywhere from 55 to 106 hours a week, with an average shift lasting 25.5 hours. Average sleep during that period was little more than a cat nap lasting just 1.9 hours. On a physical level, the work most closely resembles marathon running: residents trek up to 11km each shift and suffer a host of potentially harmful symptoms, from heart arrhythmias to dehydration, which could severely impair their performance.

Dr Zaidi says he isn't alarmed by these stats because of the checks and balances that have been worked into the system over the past 20 years. "Adverse events can happen whether you're on your first hour or 24th hour of a 25-hour shift," he says.

But for residents in specialties where being able to work 120 hour weeks is considered a badge of honour there's nowhere to turn. "There's been many a week that I've had up to 120-hours and worked more than 40 hours straight. It's not safe for [me], it's not safe for patients, and it's not conducive to a good family life," says Dr Kris Milbrandt, a general surgery resident at the Royal University Hospital in Saskatoon.

As the vice-president of the Professional Association of Interns and Residents of Saskatchewan (PAIRS), Dr Milbrandt is taking part in a CAIR committee looking into the hours worked by Canadian residents compared to their American and European counterparts.

Last July, the Accreditation Council for Graduate Medical Education (ACGME) in the US set mandatory limits, punishable by hefty fines, for all 7,800 American residency programs: an 80-hour weekly limit, a 10-hour break between duty periods, a 24-hour limit on continuous duty, and one day in seven off, averaged over four weeks. The Europeans are going even further, limiting residents to 48 hours per week by this fall.

Most provinces already have regulations in line with those of the ACGME, but they aren't implemented universally and offences aren't as systematically penalized. And as Dr Milbrant points out, when residency contracts were recently re-negotiated in Alberta, the general surgery residents were encouraged to opt out. He eschews the prevailing wisdom that you don't become a good doctor unless you work innumerable hours: "Just because something was done before doesn't mean it's a good thing."

He hopes that it won't take an event like the 1986 death of 18-year-old Libby Zion — due, in part, to negligence of an over-worked resident at New York Hospital — to change things in Canada. The ACGME's recent regulations can be traced directly back to the ruling in that case. "That's why we're working with the CAIR group to try looking at this issue and making some recommendations before something bad happens."