Traditionally viewed as a baptism by fire for future physicians, a new report said the lengthy, grueling schedules of medical residents may be hurting patients and doctors-to-be - instead of helping them.

The report, issued Tuesday by the Institute of Medicine, said medical residents - recent medical school graduates working under the supervision of licensed physicians - are too tired to safely and properly care for their patients.

To trim the number of fatigue-related mistakes, the 480-page report recommended residents working the maximum 30-hour shift should have a five-hour break for sleep. Moreover, it stated shift changes at hospitals should overlap to allow for a smooth transition between residents, and doctors-in-training should be prohibited from moonlighting at other jobs.

"This is not a trivial issue," said Dr. Thomas Santoro, associate dean for graduate medical education at the University of Illinois College of Medicine at Peoria, which administers 10 residency programs. "A fatigued physician is not practicing optimal medicine."

Santoro said two attitudes exist in older health care professionals about workloads for medical residencies - one that the long hours hurt performance, and the other scoffing that "these kids are wimps."

He said "vigorous monitoring" is needed to make sure residents are not burning out on the job and are not pressured to work longer than already allowed. To achieve that, residents at the medical college fill out a variety of anonymous surveys or self-report the number of duty hour violations.

Beside leading to errors at the hospital, sleep deprivation can be dangerous to a resident outside of the medical facility.

Dr. Sarah Zallek, medical director for the Illinois Neurological Institute Sleep Disorders Center at OSF Saint Francis Medical Center, said tired medical interns also run the risk of falling asleep at the wheel or having strained relations with coworkers and family.

"There is a lot of marital strife at home during residencies," she said.

Zallek said she supports the schedule changes but admits the proposal has an uphill battle ahead. Traditionally, medical residencies have long epitomized a grueling workload. Plus, doctors-in-training offer hospitals cheap-yet-reliable labor. The institute's report estimated the proposed changes could cost hospitals $1.7 billion.

Working on his second year of an internal medicine residency, Dr. Bhanu Paturi said his program is very strict about the hours kept by residents. On most days, he works 7 a.m. to 9 p.m. and must contact his program director if he passes the 9 p.m. deadline.

"I think this is much better," Paturi said of his situation, noting an older physician recalled working 48 hours straight. "I'm lucky I was born in a different generation. I can't imagine doing more than 30 (hours of continuous work)."

To be sure, residents are not about to abandon their duties simply because the clock's run out.

"If your patient just crashes on the floor, you can't just leave," said Madhab Lamichhane, a third year medical resident also in internal medicine.

Frank Radosevich II can be reached at (309) 686-3142 or fradosevich@pjstar.com.

By the numbers:

5 - The proposed mandatory number of uninterrupted hours of rest a resident should have during a 30-hour shift.

16 - The proposed maximum number of hours a resident can work continuously without time for rest.

80 - The maximum number of hours a resident can work each week. The Accreditation Council for Graduate Medical Education capped the number of work hours at 80 in 2003 to reduce fatigue-related mistakes.

200 - Roughly the number of residents at the University of Illinois College of Medicine at Peoria.

$1.7 billion - How much the proposed changes are expected to cost hospitals if they were to shift the work done by current residents to other personnel while the resident took mandatory sleep breaks.