DOCTOR'S ORDERS

Would patients be safer if we let medical residents rest?

- NATHAN KOHRMAN

WHEN I VISITED my cousin Beija in Munich last summer, her boyfriend, Julius, told me he was in his second year of surgery residency, and I was surprised by how well-rested he looked. He and Beija had just returned from a boozy wedding over a long weekend, and as we watched soccer, ate schnitzel at a biergarten, and met family for lunch downtown, I kept expecting him to get a text and have to leave. But the weekend kept on rolling. It was a stark contrast to medical training in America, where residents refer to two days off in a row as a "golden weekend," and spend three to seven years working 80 hours a week. As I start my last year of medical school this year, it makes me think about American medical training in a new light.

Designed by an influential 19th-century doctor with a cocaine addiction, residency in America has had extreme hours and low compensation for more than a hundred years. Today, though most residents have nearly a decade of postsecondary education-four years college, four years medical school-most make less than $70,000 a year, and work so many hours it amounts to near-minimum wage. After decades of resident-led advocacy, in 2003 the Accreditation Council for Graduate Medical Education, which oversees residency programs, capped resident hours at 80 hours a week, averaged over four weeks. In 2011, it placed a 16-hour cap on how many consecutive hours first-year residents can work, a response to research showing that a less-punishing schedule reduces serious medical errors. In 2017, the ACGME eliminated the cap on first-year resident shifts, which a recent paper found may reduce the risk of serious medical errors by 32 percent.