No more than 74 hours work per week, 24 hours at stretch by Resident Doctors: NMC

New Delhi: Noting that excessive duty hours affect the physical and mental health of medical students and compromise patient safety, the National Medical Commission's Task Force for Mental Health and Well-being of Medical Students has recommended that the resident doctors should not work more than 74 hours per week, and no more than 24 hours at a stretch.

In its report, which has recently been made public, the Task Force has also recommended that the resident doctors should be given one day off per week, a 24-hour duty, and 10-hour shifts for the remaining five days. As per the report, it is crucial to ensure medical students get 7-8 hours of daily sleep for their mental and physical health.

NMC Anti-Ragging Committee had set up the National Task Force to study existing literature and data on the mental health of medical students and propose evidence-based strategies for improving the same.

Medical Dialogues had earlier reported that this Task Force had initiated an online survey, collecting data from medical students, faculties, and administrators regarding mental health history, workload, overall stress level etc. More than 37,000 medical students had submitted their responses to the government authorities, indicating that they were suffering from mental stress.

Regulation of duty hours for resident doctors in medical colleges has been a long-pending demand of PG medical students. They often complain of being overworked and sleep-deprived due to long duty hours. Even though there have been efforts in the past to address the long working hours, doctors often stated that the policy has remained limited to paper only.

Based on the Supreme Court's direction, the Central Residency Scheme was introduced in 1992 and it addressed several issues including the number of duty hours done by a resident doctor, the issue of weekly off, accommodation of residents, leave travel concessions, etc. Under this scheme, it was mentioned that the duty hours for the resident doctors would not exceed 12 hours at a time. It had also offered them one weekly holiday by rotation.

However, these resident-friendly rules remained only on paper, and resident doctors are still found doing at least 70-80 hours of duty a week. In case of a high workload, the duty hours can further be extended. The situation is worse for clinical branches, where, in certain weeks the work hours can even reach 100 hours.

However, the NMC Task Force in its report recognized the issue and opined that "Excessive duty hours pose risks to the physical and mental health of medical students and also compromise patient safety."

Referring to the Central Residency Scheme, the Task Force noted, "To mitigate this, the government issued guidelines regulating resident doctors' duty hours (Ministry of Health and Family Welfare, Residency Scheme 1992 directive). According to these guidelines, resident doctors should generally not exceed 12 hours of continuous active duty per day and 48 hours per week. However, these guidelines were not implemented due to a shortage of human resources and other logistical reasons."

Recommendations of NMC Task Force: 

Recognizing the problem of long duty hours, the NMC National Task Force recommended that "based on feasibility, resources, and relevance, that residents work no more than 74 hours per week, with no more than 24 hours at a stretch."

"This schedule includes one day off per week, one 24-hour duty, and 10-hour shifts for the remaining five days. It is also important for medical students to sleep at least 7-8 hours per day for optimal mental and physical health," the Task Force clarified.

In the report, the Task Force has opined that collaborative planning of duty hours by HODs, faculty, senior residents and residents, requires to be done. "Department Heads (HOD), faculty members, senior residents, and Junior Residents (JRs) can collaboratively plan duty hours and roster the duty into three shifts, or two shifts, or one shift based on human resource availability. Additionally, strict adherence to the National Medical Commission (NMC) regulations for a weekly one-day off is crucial. Implementing these measures, where feasible, will help protect the health of medical students and improve patient safety. It is imperative to recognize that post-graduates and interns primarily serve educational purposes rather than filling gaps in healthcare staffing," the Task Force mentioned in its report.

"It is imperative to recognize that post-graduates and interns primarily serve educational purposes rather than filling gaps in healthcare staffing. Requests for leave should be judiciously considered and not unreasonably declined. If there is an increased clinical workload, the hospital/medical college should hire more senior residents and medical officers," the report further added.

Further, taking note of the suggestions highlighting how residents get an "unfair share of work and duties", the Task Force observed that many duties that do not fall into anyone's ambit or for which the staff is lacking gets thrust upon residents. Such duties include collecting reports, going to blood banks, moving patient trolleys, filling various forms, arranging for free medications or finances for surgery, nursing care, sample delivery, other clerical work, and data entry.

The Task Force opined that ideally each medical institute should have a clear policy of work profiles and distribution and depending on available resources, it is beneficial to employ supportive staff such as phlebotomists, clerical staff, data entry operators, and hospital attendants to manage various supportive tasks.

"Training paramedical and supportive staff can enhance work quality, public satisfaction, and patient care, enabling medical professionals to concentrate on their primary responsibilities and perform at their best," it opined.

Also Read: Responses Pour in for NMC Task Force Meeting on Mental Well-Being of Medical Students