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Michael Yaremchuk, M.D. Headshot

How Much Sleep Do Doctors Really Need?

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In Malcolm Gladwell's national bestseller "Outliers: The Story of Success," he makes his case that there is more than the Horatio Alger formula of pluck and initiative that allows young boys born into poverty to become successful. Rather, he argues that in addition to ambition and intelligence, being born in the right place at the right time makes the difference. As examples he cites the unique opportunities superstars such as Bill Gates, Bill Joy and the Beatles had to develop their talent. Gates and Joy both had unique, unlimited access to computers to start their careers. The Beatles, young lads from Liverpool, had the opportunity to play their music for hours on end in clubs in Hamburg.

But in addition to talent and opportunity, there is an important third component necessary for success -- preparation. Each of these individuals spent thousands of hours at their vocations. Gladwell cites the work of researchers who believe that the number of hours spent to reach true expertise is 10,000.

The 10,000 hour rule rings true to me, a surgeon. Although not a superstar, having put in that amount of time in the operating room, I have never been better at what I do than now -- after more than 30 years of performing surgeries. My friends (doctors, accountants, coaches, investors), all at similar stages in their careers, feel the same. The more preparation you put into your vocation, the better you get at what you do.

Until recently, the concept of "the more preparation the better your performance," held for physicians-in-training. However, the Institute of Medicine recommendations have limited residency work hours to provide more opportunities for trainee rest and presumed patient safety. Strict adherence to an 80-hour work week is stringently enforced within teaching hospitals by layers of time-consuming bureaucracy. As a result, physicians-in-training -- known as residents (because in years past they used to reside in the hospital) -- have less patient contact and less continuity of care. It will take them longer to get good at what they do at the most formative time of their career.

Although the 80-hour work week rule is intended to improve patient safety, as well as resident education and health, I have not seen any data to support these premises. Rather, in a recent study published in the journal Neurology (August 30, 2011), investigators found that under the 80-hour restriction, residents were no less tired and the quality of patient care that the residents provided declined.

In an editorial accompanying this article, Dr. Douglas Gelb, a neurologist at the University of Michigan, points out that the Institute of Medicine made these recommendations based on literature regarding effects of sleep deprivation and the time to recover, but without conducting pilot studies to see if this would bear out in practice. He writes that, "Medical education policymakers appear to have a penchant for imposing sweeping mandates based on good intentions and plausible arguments but little or no empiric evidence, and subsequent studies that raise concerns about those mandates seem to have little effect."

In today's bureaucratic world, the 80-hour rule trumps the 10,000 hour rule -- and unfortunately, I believe this means that both those training to become physicians and more importantly, patients, may suffer as a result.

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