Sleep-Deprivation is no way to run medical residency

Came across this in my tweetstream the other day. 

Father of modern surgery, William Halstead, invented the overnight call system. He thought it toughened the character. What we learned later was that his method for staying awake was cocaine. The entire on-call system for medical trainees is premised on cocaine dependence.

I have always thought the inhuman work hours expected of medical residents is mad folly. It is well-known that sleep deprivation drastically reduces performance. To the point where for some tasks even moderate sleep deprivation is equivalent to being over the (U.S.) limit for drunk driving. Why on earth would you want someone in that condition making medical decisions?

Oh, I know there are elaborate justifications. But the whole system reeks of a combination of self-interest (addicted to cheap labor), plus its-always-been-this-way-ism (accepting the clinical justifications as self-evident, my generation went through it, so why shouldn't yours). As in many questions of policy, it is useful to turn to empiricism. What do other places do? Studies suggest there are good alternatives.

For inspiration, consider working remotely. Many organizations and managers were against it, until they were forced, at the figurative point of a gun, to rely on it. Now, I think the large majority thinks it is viable, and many think remote work can be even more productive. Of course I'm not claiming that automatically proves a change of comparable magnitude would work for medical residency, but it is one more good argument for considering and experimenting with improvements.

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Postscript: I have my doubts whether the tweet is entirely accurate. The part about inventing the system is true, and so is the cocaine addiction. But it isn't clear that they go together. This Quora post claims they were not related. I generally would not like to rely on a Quora post for the final word in anything. But the original tweet contained no link, and in 10 minutes of searching, I found very little that make the cocaine-sleep deprivation-enabling connection. The one thing I found looked the likely source of the tweet. Nothing else made the link. Including this very detailed article of apparent first-rate provenance. None of which changes the fact that the US Medical Residency system is surely due for an overhaul.