Your Doctor Is More Sleep-Deprived Than Your Pilot

Since I flew last week to Orlando for both a medical conference and a family trip, I was thinking about pilots and doctors.

Last night, our flight was delayed leaving Orlando. We didn't take off until after we should have already landed at our destination. While we were waiting, I wondered if the flight would be cancelled altogether because the pilots have strict restrictions as to how long and how often they can fly.

As for me in my hospital doctor job, there are no such restrictions.

It's the Wild West.

Residency Restrictions

In residency, we had an 80 hour work week restriction. That means 80 hours is the cap per week. This is averaged over four weeks, meaning some weeks may actually exceed the 80 hours but if over the course of a month the average is no more than 80, it's following the rule.

When I was a resident, there would always be someone who wanted to report working more than 80 hours per week. It would be a way to prove the abuse. Pursuing that was always highly discouraged because of all the paperwork, meetings, and backlash that was expected.

Where did the rule come from?

The governing body of residency programs in the U.S. is called the ACGME (Accreditation Council for Graduate Medical Education).

In 2003, the 80 hour work week rule was implemented as a maximum with the goal of protecting patient safety by preventing errors and physician well-being.

Through their review, it was found that 30 hours of continuous awake time results in fatigue and fatigue results in more errors. I can tell you that without looking at any scientific data. Most people could.

There is some truth to needing experience to learn while in training, and with more time comes more learning. If you're not there as often, you won't experience as much. However, at what point is the return diminished because of fatigue?

The doctors that trained me who had trained before this rule looked down upon us for existing under the rule. It was always a “back in my day” mentality. That generational gap among physicians is very much alive and well.

This is where medical culture fails: more sacrifice equals more honor.

Pilot rules

Beginning in the 1990s, the Federal Aviation Administration started implementing rest requirements for both pilots and flight attendants.

Here are just some of their requirements:

• Duty periods of no more than 14 hours

• Flight time of 8 hours for one pilot, 10 hours for two pilots

• 10 consecutive hours of rest for flight time between 8-9 hours

• No more than 120 hours in a calendar month

  
  

The rules are extensive and very specific.

Some documents cite the Window of Circadian Low (WOCL), the period of maximum sleepiness between 0200 and 0559. Despite being doctors and presumed scientists, we neither learn of circadian biology in medical school nor honor it in practice.

Interestingly, truck drivers also have specific duty and rest requirements.

No such requirements exist for doctors responsible for lives and surgeons responsible for operations.

My After Residency Experience

The thought process behind an 80 hour work week is partially to prepare us for working while fatigued, stressed, and burned out. This isn't training, it's conditioning. It's normalizing. And it's embedded in medical culture.

When an administrator asked me within the last couple of years if this job was what I thought it would be, I replied “No, it's not at all what I thought it would be." He had no follow up response.

I now work sometimes 110 or more hours per week. The least amount I work is 70 hours, which is still more than the quoted 50-60 hour work week of attending physicians.

Where do I get these numbers?

If I work a weekend call, that's 72 hours.

On those weeks, I'll also work a 24 hour call on a weekday. Now we're at 96 hours.

That's in addition to office hours and OR time on non-call days, which is at least 14 hours of office (now we’re at 110) plus an OR day which varies.

FYI, there are 168 hours in a week.

If I don't work a weekend call, I’ll be on call two weekdays, that's 48 hours.

Add the other office days and OR time and we're around 70 hours.

If you look back to the pilot requirements, I sometimes work in a week what their maximum is for a month, all while I operate a scalpel and make critical decisions.

To be clear, this isn't a way of complaining. It's a way to clearly demonstrate the issues and outright abuse in healthcare. As dissatisfaction with healthcare grows both for patients and providers, we should examine the issues from those who have lived it.

Patients are aware of doctors leaving and doctors being rushed. Are they aware of how fatigued their doctor is? If they were aware, would they still want to be operated on?

Resources:

Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.

The author can earn commissions through affiliate links.

Disclaimer: This is not medical advice. This is for educational purposes only. Discuss with your doctor.

https://www.ncbi.nlm.nih.gov/books/NBK214946/

https://www.ecfr.gov/current/title-14/chapter-I/subchapter-G/part-135/subpart-F

https://far117understanding.com/tag/wocl/

https://www.fmcsa.dot.gov/regulations/hours-service/summary-hours-service-regulations