Regulation of Work Hours

The work hours of personnel in nearly every other high-risk industry, including aviation, trucking, railroads, shipping, and nuclear power, are regulated by legislation or by rules of statutory regulatory agencies.^[384] In aviation, these rules include daily, weekly, and monthly limits on flight duty hours (time operating the aircraft).^{[385] [390]} Limits on total duty (time at work with or without operation of the aircraft) have been proposed,^[386] because total duty time for a pilot may be double that qualifying as flight duty per se. Anesthesiologists and other medical professionals frequently violate these limits by a wide margin. In fact, nearly every on-call day for an anesthesiologist violates these limits. In 1989, the Libby Zion case^[387] in New York City brought the issue of resident supervision and fatigue to national attention. A patient's death was believed to be due to suboptimal medical care in the middle of the night, and many concluded that resident fatigue played a major role. The degree to which resident fatigue was the proximate cause is open to debate, but regulatory changes dealing with house staff supervision and resident work hours did follow in New York State. In July 2003, the Accreditation Council for Graduate Medical Education promulgated common program requirements that are designed to change resident working conditions in all medical specialties. Of note, the mandated 80-hour work week still allows for chronic sleep deprivation to ensue. Under these more stringent regulations, it is legal for a resident to work more hours in 1 to 2 weeks than an airline pilot can legally work in a month.