For the past six years, first-year resident physicians have been told they could work no more than 16 hours straight. Beginning July 1st, that will all change. They will, once again, be allowed to work 24-hour shifts, plus an additional 4 hours “to manage necessary care transitions,” according to a new ruling from the American Council for Graduate Medical Education (ACGME). The “rookie” doctors will now be able to work shifts as long as their more senior resident colleagues.
“We all agree that nobody wants tired physicians,” said Dr. Rowen Zetterman, ACGME board chairman. He said “the new rules give training programs more flexibility, help eliminate abrupt handoffs of patients and will enhance teamwork among doctors and their supervisors” (Associated Press).
“The ACGME says its decision to let first-year residents work longer hours is evidence based” (Medscape, March 10, 2017), citing a study published in the New England Journal of Medicine in 2016 in which “longer shifts and less rest in between for first-year surgical residents did not affect the rate of serious complications or surgical fatalities. And they were no more dissatisfied with their overall well-being than peers whose shifts were shorter.”
Even some residents have been advocates for longer work hours, complaining that the shorter work limit has a negative impact on continuity of patient care. First-year surgery residents, for example, are oftentimes forced to stop what they’re doing even in the middle of a surgical procedure to keep them from violating the 16-hour work limit.
Not everyone agrees that permitting longer shifts is a good idea. In an Associated Press interview, first-year resident Dr. Samantha Harrington says “the grueling hours are based on a patriarchal hazing system, where longtime physicians think ‘I went through it, so therefore you have to go through it too’.” Dr. Harrington is a member of a union group that is opposed to the new work-shift changes. Also opposed to the new ruling are the American Medical Student Association and the watchdog group Public Citizen.
“Fourth-year medical students across the country are now bracing themselves for inhuman shifts that will require them, just after graduating from medical school, to make life-or-death medical decisions and to drive home while sleep-deprived for 28 hours or longer,” says Michael Carone, M.D. of Public Citizen (fiercehealthcare.com).
Do shorter work hours help prevent physician burnout? According to a study published in the Journal of the American College of Surgeons (June 2016), “more than two-thirds of general surgery residents met the criteria for burnout, despite the majority of respondents adhering to work hour limitations.”
Acknowledging the increase in physician burnout and depression, the ACGME has asked residency programs and hospitals to take on the responsibility for promoting resident physician well-being, including better monitoring of their residents’ physical and mental health.
The new ACGME requirements leave in place the 80-hour per week work limit for all residents, and requires that they be given at least one day off per week. First-year residents are not allowed to “moonlight.”