The maximum workday for first-year medical residents just got substantially longer. The group that sets rules for training doctors announced Friday it will be scrapping the 16-hour cap on shifts worked by doctors who have just graduated from medical school.
As of July 1, the Accreditation Council for Graduate Medical Education will allow these first-year residents, also known as interns, to work 24 hours without a break — and sometimes as long as 28, if a particular transition between doctors demands it.
The ACGME is discarding a requirement that was implemented in 2011, arguing that the 16-hour cap simply did not deliver on its promises — and caused some new problems to boot.
“The Task Force [review panel] has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized,” the ACGME notes in its announcement of the rule changes, “and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole.”
For instance, task force member Dr. Anai Kothari tells Forbes the cap would occasionally prevent doctors from seeing a treatment or surgery through from beginning to end. Patients want to know “you are the doctor taking care of them,” Kothari says.
“The long shifts are infrequent, but they are important when needed.”
The group says its conclusion is based on “over 4,200 hours formulating the new requirements, including systematically reviewing over 1,000 published articles and extensive input from all stakeholders.”
As NPR’s Rob Stein reported when the rule change was proposed in November 2016, the move has its fair share of critics.
“Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public,” Dr. Michael Carome, director of Public Citizen’s Health Research Group, told Rob. “It’s disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health.”
The Associated Press notes the American Medical Student Association and the Committee of Interns and Residents also oppose the change.
The long shifts are “based on a patriarchal hazing system,” first-year resident Samantha Harrington tells the wire service. She says the underlying message from longtime physicians is: “I went through it, so therefore you have to go through it too.”
“The question of work hour standards appropriately provokes great emotion in both the graduate medical education community and among segments of the general public,” the ACGME acknowledges in its Friday announcement.
But “it is important to note that 24 hours is a ceiling, not a floor,” the group adds. “Residents in many specialties may never experience a 24-hour clinical work period.”
While the ACGME is relaxing its restrictions on interns’ shifts, it is maintaining previous regulations in other areas. Residents and fellows still cannot work more than 80 hours in a single week, and they must have at least one day off from clinical experience or education in any seven-day span.
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