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Would you be shocked to be treated by a drunken doctor?

Well, a new study says that residents -- usually the first doctor you see when you visit a hospital - are often so fatigued, their ability to concentrate and respond is equivalent to that of a drunk driver.

The research also shows that many residents, essentially doctors in training, are so sleep-deprived, they don't even recognize their judgment is impaired.

"The take-home message here is that the repercussions of fatigue on residents are considerable," said Dr. Judith Owens, director of the pediatric sleep-disorders clinic at Hasbro Children's Hospital in Providence, R.I., and author of the new study.

The researcher, who was involved in a serious motor vehicle crash after leaving a hospital where she was working a resident, said the findings also demonstrate that regulators, hospitals and medical schools need to do more to protect residents -- and by extension, the public -- from work-related fatigue.

In 2003, after a number of studies showed the impact of gruelling residency training, an 80-hour-per-week cap was established in the United States, though it remains a recommendation, not a legislated limit. Canada does not have a cap on the number of hours that can be worked, but various provinces have introduced various rules in recent years. For example, in Ontario, residents cannot work more than one night in four in addition to their day shifts. Some hospitals have rules that no shift can extend beyond 30 hours.

"Right now, the worst a resident might do is 36 hours straight," said Dr. Benjamin Hoyt, president of the Canadian Association of Interns and Residents.

"Is that good? No it's not. But it's a lot better than it was. We're making a lot of progress in Canada. A lot more than in the U.S.," he said.

The new study, published in today's edition of the Journal of the American Medical Association, involved 34 pediatric residents from Brown University in Providence who were followed over two years.

During that time, they were tested under two particular circumstances, namely during:

Light call (one month of daytime duty with no overnight shift), with an average of 44 hours of work per week. They averaged six hours, 37 minutes of sleep a night;

Heavy call (overnight duty every fourth night), with an average of 90 hours a week. Residents averaged three hours, 26 minutes of sleep a night.

The residents were tested four times in total after their shifts: Twice following light call, one time during which they drank four vodka cocktails; and twice following heavy call, again once after consuming alcohol that left them with a blood alcohol level of 0.05, which amounts to 50 milligrams of alcohol per 100 millilitres of blood. (In Canada, the legal limit is 0.08, but in some U.S. states it is now 0.05.)

The residents performed computer tests to gauge their attention and judgment, and spent 30 minutes in a driving simulator.

Not surprisingly, those in both groups who consumed alcohol before the tests performed poorly. But the residents who were on heavy call and had not consumed alcohol performed worse than even those on light duty who had taken alcohol.

Dr. Hoyt said that while he believes prolonged work hours are not beneficial for residents or patients, the new findings need to be interpreted with caution.

"I've done 36-hour shifts and been completely exhausted. And while I'm not a big drinker, I've been drunk a few times. I can tell you that those two conditions are not at all alike," he said.

"If you tell people there are a bunch of drunk doctors out there in hospitals, they will be alarmed. But that's not the case," Dr. Hoyt said.

He said that residents are always under the supervision of a senior physician, which minimizes errors.

Like it or not, Dr. Hoyt added, residents, and surgical residents in particular, have to learn to work long hours because that is the reality of the profession.

"Medicine is a 24-hour-a-day, seven-day-a-week profession. The unfortunate reality in Canadian health care is there are not enough bodies to go around. With the current numbers, it's not possible to ensure that nobody works more than eight hours or 12 hours each day," he said.