The doctor scheduling dilemma

In recent times, it's become clear that the old-fashioned system of working doctors around the clock and giving them erratic schedules is a problem. Some veterans continue to insist that 24-hour shifts and unpredictable hours are just part of the job, but others have begun to admit that times have changed.

By just about any measure, the problem is reaching crisis levels. Not only do mixed-up schedules and sleep deprivation cause physician burnout and job dissatisfaction--driving many to consider a new career--research is piling up suggesting that unpredictable hours and long shifts can lead to medical errors. For example, a recent AHRQ study found that when interns worked five 24-hour-plus shifts, medical errors went up a remarkable 700 percent, and the chances of making errors causing death increased 300 percent. Those numbers knocked me back in my chair when I read them, and they should alarm the heck out of providers, too.

The question is, when will the studies and task forces end and real change begin? Despite scientific evidence that doctors can't function without sleep or work with a complete lack of structure better than other mortals, many facilities still expect interns and doctors to work like machines. Clearly, the medical culture is very resistant to change--especially on this issue--but somebody's going to have to lead the way.

If hospital execs don't begin to make some shifts in physician schedules, Congress make take matters into its own hands. Just this week, a group of U.S. House Energy and Commerce Committee Members asked AHRQ to do another study into the relationship between physician schedules and medical errors. If this new AHRQ study reaches the expected conclusion--that doctors aren't machines--legislation is likely to follow.

Instead of letting lawmakers make (possibly wrongheaded) attempts to regulate physician work schedules, why not start a physician working committee in your hospital looking at ways to create realistic, human and safe schedules? (You could probably slide in a discussion of how to structure realistic on-call schedules, too.) Ultimately, reducing burnout and cutting medical errors are in everyone's interests. And you'll probably save thousands on coffee, too. - Anne

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