Brief history of why doctors work 28-hour shifts

Doctors all worked unlimited hours—unchallenged until Libby Zion’s death on March, 5, 1984. Her dad found her care was left to sleep-deprived residents with no supervision. Legal battles ended in New York’s 1989 Libby Zion Law—requiring doctors-in-training be supervised and limited to 24-hour shifts and 80-hour weeks. In 2003 these caps were applied to all US residents and in 2011 new doctors were capped at 16-hour shifts. Yet caps remain unenforced so residents may still work unlimited hours. In 2016, we delivered a 75,000 signature petition to Dr. Nasca at the ACGME, demanding the agency charged with resident training address sleep deprivation and doctor suicides. In response, they nearly doubled new doctor shifts from 16 to 28 hours in 2017 and now permit unlimited hours without justifying why. If this bothers you, tell the ACGME (and your hospital)—that your doctor has a right to sleep or you have a right to see another doctor.

Protect yourself & your loved ones. Always ask, “How long have you been on your shift, Doc?” 

Let the ACGME and Dr. Thomas Nasca know how you feel about their decision to allow doctors to work 28+ hours without sleep: Accreditation Council for Graduate Medical Education 401 North Michigan Avenue, Suite 2000, Chicago, IL 60611 or call 312.755.5000. Email Dr. Nasca: tnasca@acgme.org

Hazardous work hours in our hospitals lead to deadly medical mistakes, doctor suicides & fatal car accidents.

Your legal defense strategy: Human Rights Violations in Medicine: A-to-Z Action Guide

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18 comments on “Brief history of why doctors work 28-hour shifts
  1. Corporate (wrongfully referred to as ‘organized’) medicine is knowingly abusing its indentured servants, and as you’ve noted, they abide by no restraint. They pride themselves on their myriad shields from prosecution via whatever insider legislative connections they manipulate, and combine these with shaming of “trainees” if one can’t “rise to the challenge.”

    They compel their servants to mount a legal challenge which is a nearly insurmountable legal burden.

    Absent the collective voice of “housestaff” unions (what a pejorative term, why not just call them “the help”), it seems that a collective outcry is needed along with a flood of complaints to federal regulatory enforcement bodies.

    I can envision three potentially powerful approaches – OSHA; EEOC; and the malpractice insurers of PGYs (generally a group contract).

    For now, for those at rights-abusing institutions, it’s worth considering filing a complaint with OSHA: https://www.osha.gov/right-to-refuse.html

    It’d be best to do this collectively where abuses have been documented. It will also be worth exploring the teams of lawyers who represented plaintiff Zion and seeing if any might be interested in pursuing this.

    Like the history of other rights abuses (e.g. child, unsafe working conditions et al.), it takes a defiant outcry and a demand for correction.

    I think it will also be important to involve the organized forces who are the representative bodies, e.g. the Joint Commission, state and national hospital associations, FSMB, state and national medical associations, ACGME et al. to inform them via certified letter that these abuses are occurring and ask them what their stance is. A record of the patterns of abuses will be vital. If they have chosen to ignore the correspondence or not investigated, then when class litigation emerges which it inevitably will, they can be implicated for their complicity and all resultant harms.

    Unfortunately, we’ve arrived at a level of problem resolution that is no longer based on reason but on adversarial interaction. If that’s the only language they speak, then so be it.

  2. Irina Campbell says:

    Dear Dr. Wible: Forgot to mention in my last email to you that since I receive the Spanish International News Station (through Dish Network) I am aware that recently all the primary care providers in Spain went on strike! They wanted more time with the patients, and went on strike recently. They continued the strike for two or three months until the dispute was settled.

  3. Dr. Gwendolyn Atwood says:

    Dear Dr. Nasca and Members of the Accreditation Council,

    When I was four years old, my father, just after having been elected chief resident in internal medicine at his Harvard teaching hospital, killed himself in his car in the parking lot, leaving myself and three other children all under the age of six.

    My father was very sleep deprived, as I understand it. He often worked over 36 hour shifts.

    It’s simply criminal that your organization actively promotes seriously sleep-deprived doctors caring for needy people, when they obviously cannot even care for themselves under such conditions, not to mention those children and other family members also in the care of doctors in training.

    It’s truly disgraceful that on the 36th anniversary of the Libby Zion decision, people such as myself should have to be writing to demand basic human rights protections for doctors so that neither they nor their patients and others in their care are harmed by practices required by their training institutions.

    Sincerely,
    Dr. Gwendolyn Atwood
    Winchester, New Hampshire

    • Pamela Wible MD says:

      Thank you Gwendolyn for being courageous to speak the truth about such a tragedy in your life. I hope many more will come out of the shadows and speak openly about the impact of our failed medical education model that has wounded so many (and continues to wound their children and grandchildren). Watch this video of one doctor trying to come to terms with severe childhood neglect by his father surgeon: https://www.youtube.com/watch?v=Q2J-QbkLNwg

  4. Paul Dawson says:

    I worked in hospital to get money while I was in college. This was in the late 60s. Interns were so exhausted they looked like bloodless ghosts. I remember one Christmas eve when we had two patients dying across the hall from each other. I called the intern on call and he came down in his greens all disheveled, saw what was happening, threw up his hands and said, “My god what do we do?” I said, “That’s why you’re here.”
    It was awful. More doctor torture than help. They would go 72 hours or longer without sleep.
    BEST,
    Paul

  5. Doctor D says:

    good morning Pamela, I remember the case well and cite it frequently in such discussions,
    and I expect with you, too. I was an intern that year and worked those long hours, and we
    were fine because our system did not break down; we had support from all sides. it was 1
    year, and that experience was important. for Libby Zion, the system collapsed at all points
    from her PMD to RNs to resident staff to attendings; it was a major tragedy validating the
    Concept of Perpetual Human Stupidity. If they care, then they would do something. Well
    they have piddled, and the shit continues to flow (gush) down from the good ol’ boys.
    Personally I did experience a break down in another city in another state, twice in a month,
    and the only one hurt both times was me when the chief resident ignored me, put me down, and
    lied; Never will I forget that face or name. And that is part of why, when I had the opportunity,
    I walked away and never looked back. The system and the profession is staid and it is
    conservative and it is just another power broker where I never fit in and never would. I have
    a long history of questioning authority when it is wrong, and that is not to their liking.
    And you my dear are busy challenging them where it hurts. Humans love and crave power.
    It is quite Machiavellian, whatever it costs you does NOT matter just long as they have
    money power control. Human (not huwoman) history (not herstory) is rife and loaded
    with hate cruelty violence. Just imagine ‘men of (the) god(s), love and peace, came up
    with the Inquisition with such shit as ‘I love you I must kill you for heaven eden paradise jesus.’
    Holy Shit Batman, what ludicrous asinine gore. Keep up the good fight; I am rooting for you.
    I expect to be in the City in a couple months and hope so have a coffee with you. Cheers

  6. William Wenner says:

    On Mar 5, 2020, at 9:23 AM, William Wenner wrote:

    Dear Dr. Wible,

    Your work on improving the lives of medical workers is remarkable. So it is critical that you do not lose your effectiveness.

    You might want to reconsider the complexity of the Libby Zion case. Over the years, as the facts have come out, the supervision issue, though championed by her family, was probably not a major contributor to her death. Information access, particularly what medications she was taking, lack of appreciation of the serotonin syndrome and failure to rescue due to adequate staffing were more likely to have been the causative issues.

    You might start here: https://epmonthly.com/article/serotonin-syndrome-and-the-libby-zion-affair/

    This does not diminish the dangers of overworked healthcare workers. But as we fight the forces of economics that thrive on the current environment, we need to sharpen our arguments and presentations. One misstep and our effectiveness weakens.

    Good luck with your noble efforts.

    William Wenner
    Professor Emeritus, Pediatrics

    • Pamela Wible MD says:

      Thank you and yes the complexity of the case condensed into 60 second video for modern short attention spans leaves a lot out!

  7. Carmen says:

    Thank you Dr.Wible for caring

    • Pamela Wible MD says:

      Labor of love and quite frankly I’s still shocked that such hazardous and unsafe working conditions are permitted in 2020!

  8. Cindy says:

    Thank you for keeping me and others informed. I have sent an email to the address listed. I hope others will as well.

    Cindy

  9. JoaAnn says:

    Dear Dr. Wible
    After forwarding your article, I received this reply from a friend. Finding this article and its information surprised me! https://curiosity.com/topics/doctors-have-long-shifts-for-a-very-important-reason-curiosity/

    Makes me furious and I can see what you are up against. Care to comment?

    Thanks
    JoAnn

    • Pamela Wible MD says:

      That article is is full is misleading content.

      This is WRONG:
      1) Reducing Work Hours Doesn’t Reduce Errors — NOT TRUE. Read this: Sleep-deprived docs disclose hospital horrors

      2) Patient Hand-Offs Introduce Risk — NOT TRUE if people are overworked it’s the SAME as being drunk. Do you want a drunk doctor or an alert one? Same concept with the DESIGNATED DRIVER. Do you want to stay in the car with your drunk friend or a hand-off to an alert one who is sober? Do you want to get in a plane with a pilot who is flying the plane from India to USA (more than 24 hours) or do you want a hand-off to a pilot who slept last night and ate breakfast?

      Sleep deprivation is more dangerous than driving under the influence of alcohol. In fact, being awake for 24 hours is like having a blood alcohol concentration of 0.10 percent (beyond the legal limit in the United States). Here are harrowing tales of physicians just trying to get home after a shift. Sadly, some never make it.

      Examples of doctors who nearly died (or died) due to unsafe working conditions because work hours were not reduced tp safe levels (< 16 hours) “I ran a red light driving home in residency after a 36-hour shift. Got pulled over. It was sobering: I was not fit to use my driver’s license, but I had just been using my medical license for over a day nonstop!” “During internship I was driving home after a 30-hour call. I got on the highway going the wrong direction. Thankfully, a police car pulled me over as I was going into oncoming traffic. He escorted me all the way home.” “A dear friend from med school died during her neurosurgery residency. Drove over a median into a tractor trailer after a 30-plus hour shift. She left behind her family, including a twin sister and her fiancé. She was 30.” Examples of medical mistakes: (besides Libby Zion) “I have made numerous medication errors from being over tired. I also more recently misread an EKG because I was so tired I literally couldn’t see straight. She actually had a subarachnoid hemorrhage and by misreading the EKG I spent too much time on her heart and didn’t whisk her back to CT when she came in code blue. She died.” “As a resident in a surgical specialty, my program routinely violated work hours, yet our attending physicians kept talking about how lucky we are because we have “work hour restrictions.” To fool my brain into not stopping, I’d lie to myself. I’d tell myself that if I just got out of bed at 3:30 one more time I could go to bed early that night, or if I just got through a few more notes I could go home and finish the rest tomorrow. I thought I could just keep going at that pace and nothing terrible would happened until I woke up in the ICU and a doctor told me I had tried to kill myself.” “I did my internship in internal medicine and residency in neurology before laws existed to regulate resident hours. My first 2 years were extremely brutal, working 110 – 120 hours/week, and up to 40 hours straight. I got to witness colleagues collapse unconscious in the hallway during rounds, and I recall once falling asleep in the bed of an elderly comatose woman while trying to start an IV on her in the wee hours of the morning.” There are more . . .

  10. RM says:

    I was so incensed at the emotional toll borne by physicians.
    ALL the time .

    My years of depression and self doubt have again given way to anger
    and a need to bring these issues out in the open. Sunlight is toxic to these abusers, generally male but I had a female “colleague” also in that category.
    We do not have the money to hire crooked lawyers as Institutions do.

    We just want to practice a noble profession. Thank goodness my love for medicine is unabated. I love the science behind it also.

    The behaviour we are subjected to could kill our love for our profession.

    My joy will increase as these views become available to trainees, and hopefully help them in times of stress and grief.

    There is no reason for another generation to suffer in silence;

  11. ACGME non-response says:

    Wrote a letter.
    An FYI–No response from ACGME Dr Nasca thus far;
    as expected I guess and I am a nobody so he could care less!

  12. Cindy Whitcomb says:

    Dear Dr. Nasca,

    It has come to my attention that doctors are being pushed to work (28+ hours) too many hours on shift without sleep.

    It is just astounding to me that you, as a doctor, would be in support of no mandatory limits on how long a doctor-or resident-can work without sleep. You are an educated man, and you know that this is absurd.

    For the sake of the patients, the doctors, and the well being of the vocation, please rethink this issue. It would be such a win for all of us if learned doctors would take a stand and insist on positive change. Please, be that doctor.

    Thank you,
    Cindy Whitcomb

  13. Rajalaxmi McKenna MD FACP says:

    Dr Thomas Nasca,
    CEO ACGME

    I write to you as a physician scientist who spent about three decades in academia with joint appointments in multiple departments, running laboratories, designing and running trials, seeing patients 12 months a year, teaching in all departments working across disciplines, working with Federal Agencies and IRB’s, in Big Pharma and in private practice. It is based on all that experience that I write to you now, to rectify our “haloed” profession.

    It is unconscionable that in this day and age, that as physicians, knowing the serious, negative physiological and psychological consequences of sleep deprivation on a human being, that you, as a regulatory agency, have and continue to approve the decision to allow doctor-trainees to work for 28+ –>unlimited hours without sleep !

    This is a clear human rights violation. This contributes to physician suicide. How can an organization that accredits Universities in the training of the most demanding, educated profession turn a blind eye to these practices?

    In addition, it places patients at risk, through no fault of the trainees.

    The responsibility lies with Universities/Institutions profiting from the enforced “cheap” labor and crediting organizations like yours that allow this practice to continue. And, as you and the Universities understand well, trainees cannot complain about these inhuman conditions imposed by and perpetuated by their “supervisors”, the Chairmen of their Departments, the Deans and Boards of these Institutions, because the trainees are dependent on recommendations for their future from the very same “supervisors” with unlimited powers. No neutral, powerful, outside organization exists that trainees can appeal to. But Institutions have their money and bevy of lawyers to justify and hide their ignoble actions. Your organization and University systems know fully well that housestaff do not have the resources to mount a legal challenge to these unsafe policies.

    Attendings must start earning their living, unlike now when they are excused for a variety of internal political reasons. As you are well aware, housestaff are chastized by Attendings , even when simply called late in the evening or at night for crucial advice. Attendings must get up at night and see critically ill patients–a practice not in place even now.

    Perhaps funding for your organization is dependent on the very Universities that it regulates–I do not know. If yes, that is an obvious and serious conflict of interest.

    I sincerely hope that the moral compass will prevail at ACGME, to right this wrong. Such policies would not be allowed for pilots–procedures that are touted by Medical Institutional CEO’s to “improve” quality of medical care.

    Rajalaxmi McKenna MD FACP

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