Hospital hazing: death by licensing

Reason, May, 2005 by Jesse Walker

A REPORT IN the January 13 New England Journal of Medicine argues, with mathematical exactitude, that you're more likely to get into an accident driving home from the hospital if you've just spent 32 hours working there. That shouldn't be a surprise, but evidently it's a point that needs to be driven home. Shifts of 24 hours or more are "a hallmark of medical education in the United States," the paper notes. What's more, such conditions are not imposed in the face of regulatory opposition but "sanctioned by the Accreditation Council for Graduate Medical Education." (The Council has added new limits to interns' work hours since the study was concluded, but shifts can still last as much as 24 hours.)

This setup still has defenders, despite decades of evidence that it puts not just drivers but patients at risk. When The Washington Monthly's Kevin Drum commented on the New England Journal article, he remarked that the system's supporters "sound like nothing so much as a bunch of '50s frat boys defending hazing after some freshman has been found dead in an arroyo somewhere." Hazing is the perfect metaphor, since the system serves mostly as a brutal initiation to a privileged club.

Those long shifts are part of the set of barriers that limit entry to the medical profession. Whatever other reasons exist for them, they're ultimately a byproduct of occupational licensing. They don't just undermine public health. They drive away qualified men and women, reducing the supply of doctors and allowing those who survive the trial to charge more for their services.

Medical mistakes are among the top 10 causes of deaths in the United States.