Resident doctors’ duty hours: NMC tells Supreme Court states must enforce limits, reigniting debate on burnout and patient safety

India’s top medical education regulator has told the Supreme Court that while it supports “reasonable” duty hours for resident doctors, the responsibility for actually enforcing working‑hour limits lies with state governments and individual medical institutions. The statement, made by the National Medical Commission (NMC) in a counter‑affidavit in an ongoing public interest litigation (PIL), has sharpened a long‑running conflict over “inhumane” shifts, mental health risks, and the thin line between training and exploitation in Indian hospitals.

What the case is about

The PIL before the Supreme Court has been filed by the United Doctors’ Front (UDF), a national body of doctors, challenging what it describes as “exploitative and unconstitutional” working conditions for resident doctors across India. The petition seeks strict implementation of a 1992 notification issued under the central residency scheme, which capped resident doctors’ duty at a maximum of 12 hours per day and 48 hours per week.

The Ministry of Health and Family Welfare’s notification (No. S‑11014/3/91‑ME(D), dated 5 June 1992) laid down binding norms: continuous active duty should “not normally exceed 12 hours per day” and junior residents “should ordinarily work for 48 hours per week,” with weekly off and limits on on‑call duty. More than three decades later, the UDF argues that these norms remain largely “on paper” even as residents routinely report working 24–36 hour stretches and more than 80–100 hours per week in many institutions.

In an earlier hearing, the Supreme Court issued notice to the Union government and the NMC, asking them to respond to allegations of “inhuman” duty hours and non‑compliance with the residency scheme. The matter remains pending, with the next hearing expected later this month, according to UDF president Dr Lakshya Mittal.

NMC’s position: flexible “reasonable” hours, states to implement

In its counter‑affidavit, the NMC has told the apex court that it has “already taken necessary steps” to address duty hours and mental wellbeing but emphasised that its statutory mandate is to regulate medical education and academic standards, not to run hospitals or service conditions.

Key points from the NMC’s stand include:

• Reference to PGMER 2023: The NMC says it has consciously adopted the concept of “reasonable working hours” and “reasonable time for rest” in the Post Graduate Medical Education Regulations (PGMER), 2023, in line with the 1992 Residency Scheme. Rather than specifying rigid numeric caps, the regulations allow institutions to adapt schedules based on local patient load, staffing, and speciality‑specific needs.

• Avoiding rigid numerical limits: The commission argues that fixed hour caps could, in some settings, compromise patient care and hands‑on training if not matched by adequate staffing and infrastructure.

• States’ constitutional role: Citing the Constitution’s State List entry on “Public health and sanitation; hospitals and dispensaries,” the NMC contends that state governments are empowered—and therefore primarily responsible—to set and enforce working‑hour rules within their jurisdictions.

• Union government’s prior clarifications: The affidavit points to a 2018 reply in the Lok Sabha where the Centre clarified that fixing duty hours for doctors in government hospitals is “primarily the responsibility” of state governments and Union Territories.

As an example of better practice, the 2018 parliamentary reply noted that in some central government institutions—such as AIIMS New Delhi, Safdarjung Hospital, Dr Ram Manohar Lohia Hospital and Lady Hardinge Medical College—working hours “normally do not exceed 40 hours per week,” though emergency needs can alter rosters. Subsequent institutional circulars, like AIIMS New Delhi’s 2025 directive enforcing 12‑hour shifts and a 48‑hour week, also cite the same residency scheme guidelines.

Mental health crisis and NMC’s task force

The NMC’s affidavit also highlights rising rates of depression and suicides among medical students and residents, and flags steps taken to address mental health. In 2024, the commission constituted a 15‑member National Task Force on Mental Health and Well‑being of Medical Students to study stressors, burnout and psychiatric morbidity in medical colleges.

The task force:

• Visited multiple medical colleges across India and held focused group discussions with administrators and department heads on mental‑health challenges and existing good practices.

• Conducted online surveys among undergraduate and postgraduate students and faculty to gather detailed information on stress, workload, harassment, and access to support.

• One of its most debated recommendations is a weekly cap of 74 working hours for residents—with not more than 24 hours of continuous duty, one mandatory weekly off, and 10‑hour shifts on the remaining five working days. This proposal, significantly higher than the 48‑hour cap in the 1992 notification, is presented as a “feasible” interim target given current staffing and caseload realities.

The task force also called for:

• 24/7 confidential mental‑health support services on campuses, including better use of programmes such as Tele‑MANAS

• Integrating mental‑health education, stress management and resilience training into undergraduate and postgraduate curricula.

• Strengthening counselling services and ensuring at least two counsellors per 500 students.

Resident doctors’ concerns: “Not robots”, patient safety at risk

Doctor‑led groups say that while policy language has evolved, ground‑level enforcement remains weak. The UDF maintains that resident doctors remain “the backbone” of both government and private hospitals, yet are often overworked and under‑protected.

“Resident doctors are the backbone of both government and private hospitals, yet they continue to be overworked and exploited,” UDF president Dr Lakshya Mittal said in response to the NMC’s affidavit, reiterating that the 1992 duty‑hour norms are “routinely violated” despite repeated representations to authorities, including a letter to the Prime Minister.

In its petition, the UDF argues that:

• Excessive, unregulated duty hours violate residents’ fundamental right to life with dignity under Article 21 of the Constitution.

• Chronic sleep deprivation, burnout and mental‑health problems among residents compromise both doctors’ welfare and patient safety.

• When residents work 24–36 hours without rest, their cognitive performance, judgement and reaction time decline, increasing risks of diagnostic and medication errors—concerns echoed in international studies linking extended shifts to higher error rates and near‑miss events.

The association is urging the Supreme Court to direct uniform enforcement of the 48‑hour weekly cap and 12‑hour shift limits as a non‑negotiable baseline, with robust monitoring and penalties for institutions that do not comply.

Expert views: balancing training, service and safety

Experts not involved in the litigation say the debate must balance three realities: training needs, service demands, and the health of both doctors and patients.

“Extended clinical exposure is essential for residents to gain confidence in managing emergencies and complex cases, but there is a threshold beyond which fatigue becomes dangerous,” said a senior academic intensivist at a government medical college in North India, who requested anonymity because of the pending case. “Global evidence suggests that once you cross roughly 80 hours per week or more than 24 hours continuously on duty, both error rates and burnout indicators rise sharply.”

A public‑health policy expert at a leading Indian institute added that merely shifting responsibility between the NMC, Centre and states will not solve the issue unless there is transparent reporting. “We need mandatory logging of duty hours, anonymous reporting mechanisms, and periodic audits by independent bodies. Without data and accountability, terms like ‘reasonable hours’ become meaningless for young doctors on the ground,” the expert said.

Comparisons with international practice also highlight the gap. For instance, in the United States, the Accreditation Council for Graduate Medical Education (ACGME) caps resident duty hours at 80 hours per week averaged over four weeks and limits continuous duty periods, while the European Working Time Directive sets a 48‑hour weekly limit across sectors, including healthcare. Indian residents, by contrast, often face workloads exceeding both these benchmarks in busy tertiary centres.

Public‑health implications

While the dispute appears focused on doctors’ working conditions, the stakes are broader for public health and patient care. Excessive duty hours among resident doctors can have ripple effects:

• Patient safety: Fatigue‑related errors can lead to misdiagnosis, delayed interventions, and medication mistakes—especially in high‑risk areas such as intensive care, obstetrics, emergency medicine and anaesthesia.

• Quality of training: When residents are chronically exhausted, they may spend more time surviving shifts than engaging in reflective learning, academic work, and supervised skill‑building.

• Workforce sustainability: Prolonged burnout and poor mental health can push young doctors out of clinical careers or drive them overseas, worsening India’s already uneven distribution of healthcare workers.

For health‑conscious readers, this debate also matters because resident doctors form the first line of care in most teaching hospitals and many large public facilities. The quality of attention, communication and clinical decision‑making patients receive at odd hours often depends on how rested—or exhausted—the resident on duty is.

What this means for patients, doctors and policymakers

For patients and families:

• Do not hesitate to ask who is supervising your care, especially during nights and weekends, and whether senior consultants are available for escalation if required.

• Recognise that residents you meet in teaching hospitals are doctors in training who often handle high caseloads; clear communication, sharing complete histories, and asking clarifying questions can reduce the chances of misunderstandings.

For resident doctors and medical students:

• Document duty hours and maintain records where possible, as some institutions and courts increasingly demand objective data to verify claims of overwork.

• Seek support early for mental‑health concerns, including through institutional counsellors, Tele‑MANAS, or external mental‑health professionals, given the elevated risk of depression, anxiety and suicidality documented in medical trainees.

For policymakers and administrators:

• Align institutional duty‑hour policies with both the 1992 residency scheme and current NMC recommendations, while working toward realistic staffing plans that do not rely on chronic overwork of residents.

• Institute transparent duty‑hour tracking, routine audits, and meaningful grievance‑redressal mechanisms so that violations are identified and corrected rather than normalised.

As the Supreme Court examines the UDF petition and the NMC’s position, the outcome could redefine how India balances training, service delivery and human rights in medical education. For now, the case has thrust the invisible labour of resident doctors—and the health risks of overwork for both providers and patients—firmly into the national spotlight.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health‑related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References

1. https://medicaldialogues.in/news/health/doctors/resident-doctors-duty-hours-implementation-lies-with-states-nmc-tells-supreme-court-163936