Resident Duty Hours and the Ripple Effect

Apple Podcasts | Google Podcasts

Session 39

Session 39

In this episode, Ryan and Allison discuss a controversial topic, which is huge in residency today, specifically the residency work hour restrictions.

Even if you’re still a premed, you need to understand that the amount of time residents work currently is much less than it used to be. As the house staff, residents practically live in the hospital to be able care for the patients.

A brief history of the Libby Zion Law

  • Switch to 36-hour work shifts until in 1984 when a patient Libby ZIon died in New York
  • Two years later, the courts ruled that her death was the cause of resident fatigue from the 36-hour shifts and a lack of oversight from attending physicians.
  • As a result, that state of New York has put a limit on resident work hours.
  • ACGME, the oversight body for all residencies in the US has also put a work hour restriction for everybody to where there is just an 80-hour averaged workweek for all residents and fellows.

Recently, that has been changed to 16-hour max workdays for interns with no overnight call, a 24-hour patient care and 4-hour transition of care period for residents.

So you would expect a decrease in medical errors now that residents are more rested, right?


An article in the New Yorker about Why Doesn’t Medical Care Get Better When Doctors Rest More as well as lots of research coming out actually suggest that the work hour restrictions are actually not increasing patient care results. In fact, there is an increase of medical errors reported by residents.

Here are the highlights of the conversation with Ryan and Allison:

Sleep deprivation is an underappreciated problem:

  • A cause of cognitive impairment
  • Obstructive sleep apnea is associated with increased risk of stroke, heart attack, and other serious medical problems
  • Just as dangerous as drinking and driving since your judgment will be severely impaired
  • Increased risk of driving accidents

The consequences of the changes in work hour restrictions:

More handoffs

Patient handoff is when a physician currently working in a hospital hands off the patient and patient care to another physician that’s coming in to take over for that patient to replace that physician so he/she can go home and sleep.

  • The covering doctor doesn’t know the story or what happened the course of the hospital stay
  • They only get snippets of to-do items left over from the list
  • Lack of contacts
  • Patients and families are meeting more physicians. Physicians are knowing their patients less and vice versa. Unfortunately, the patient-family dynamics that you get to learn is not part of the handoff.
  • Doctor-patient relationship is broken down due to the lapses in the continuity of care

The change in education of residents, interns, and medical students

  • Disrupted rounds
  • Interns and medical students lose out on the attending physician’s expertise and teaching
  • Not seeing the evolution of illness

The ripple effects:

  • Less hours working, more hours resting
  • Hospital’s struggle to have same number hours a day and same amount of work with less people to work those hours and
  • Increase cost to hospitals with a Huge rise in the need for assisted healthcare professionals, PAs
  • Decrease in hours, increase in errors

Links and Other Resources:

Why doesn’t medical care get better when doctors rest more?

A brief history of duty hours and resident education

Libby Zion Law

Doctors-in-training spend very little time at patient bedside, study finds

Save $225 on the Princeton Review’s MCAT Ultimate or MCAT Self-Paced Prep Course through March 30th 2016 by going to

If you need any help with the medical school interview, go to Sign up and you will receive parts of the book so you can help shape the future of the book. This book will include over 500 questions that may be asked during interview day as well as real-life questions, answers, and feedback from all of the mock interviews Ryan has been doing with students.

Are you a nontraditional student? Go check out

For more great content, check out for more of the shows produced by the Medical School Headquarters including the OldPremeds Podcast and watch out for more shows in the future!

Free MCAT Gift: Free 30+ page guide with tips to help you maximize your MCAT score and which includes discount codes for MCAT prep as well.

Hang out with us over at Click join and we’ll add you up to our private Facebook group. Share your successes and miseries with the rest of us.

Check out our partner magazine, to learn more about awesome premed information.

Blueprint MCAT (formerly Next Step Test Prep): Get one-on-one tutoring for the MCAT and maximize your score. Get $50 off their tutoring program when you mention that you heard about this on the podcast or through the MSHQ website.

Listen to our podcast for free at iTunes: and leave us a review there!

Email Ryan at or connect with him on Twitter @medicalschoolhq

Tweet Allison @allison_mshq or send her an email at