Tired doctors: The case in Quebec

In most parts of Canada, medical residents often work 24- to 26-hour shifts. But in Quebec, resident shifts are capped at 16 hours. Here’s how Quebec shifted gears on how long doctors should work.

When he was a resident at McGill University Health Centre, Dr. Alain Bestavros felt his marathon shifts were putting his patients -- and himself -- in danger. And he decided to take a stand.
In May 2007 Dr. Besatvros filed a grievance contesting the validity of 24-hour call duty shifts. At the crux of his argument, Bestavros argued that such long shifts are contrary to the Canadian and Quebec charters of rights.

Bestravos believed that call duty schedules should not exceed 16 hours in a 24-hour period.

​"​I think most residents had experienced these very prolonged shifts at the edge of sleep deprivation,” he says.

“And they've all experienced the effects it can have, both on our mental acuity, our physical well-being; even our mood is changed by such prolonged period of lack of sleep.”

The case went to arbitration almost two years after Bestavros filed the grievance.

Dr. Charles Czeisler, Baldino Professor of Sleep Medicine at Harvard Medical School and senior physician in Brigham and Women's Hospital’s division of sleep medicine testified why long shifts are detrimental for both patient and physician.

"In our studies, we found that limiting the shifts to no more than 16 consecutive hours significantly reduced the risk of serious medical errors,” he says.

“Working these marathon shifts also put significant risk on the resident physicians themselves,” he says. “We found that they had 170 per cent risk of motor vehicle crash, driving home from these marathon shifts.”

“Once they got beyond 20 hours, they had more than 70 per cent increased risk of stabbing themselves with a needle or a scalpel when they were using these sharp objects in the care of patients.”

While the case was in arbitration, an independent survey in Quebec on medical resident work hours found that 84 per cent of people believed medical residents in hospitals should work between 40 and 60 hours a week. And 92 per cent believed residents in hospitals should never be allowed to work more than 16 consecutive hours.

Only 8 per cent felt that 24-hour shifts were OK. And almost three quarters said that patients should be informed if the resident treating them had been in the hospital for more than 16 hours.
"It was a time where these studies were coming out fairly, very regularly in big scientific journals, showing that sleep, a lack of sleep is associated with significant detrimental effects, both on residents and on the patients,” Bestavros says.

In 2011, almost four years after Bestavros raised the issue, arbitrator Jean-Pierre Lussier decided resident shifts should be capped at 16 hours, and that 24-hour shifts violated the Canadian Human Rights Charter.

Finally, in July 2012 - 16-hour call duty schedules are put in place in Quebec. For Dr. Bestavros, it was just the first step in an ongoing effort.

"I think most people are aware that it's the beginning of something else. It means that we have at least clarified that 16 hours is the limits for most residents to be working continuously. But beyond that we understand that implementing this concretely in the day-to-day lives will require a lot of work. In fact we've seen it; programs across the country, across the province I should say, have had to adapt and shuffle around the schedules to make it possible, practically possible, while maintaining as good as it gets patient care, the best patient care possible."
For more details go to: