Today the ACGME announced its official decision to roll back the 16-hour limit on consecutive work for first year residents, returning to 28-hour on-call shifts, performed with little or no sleep. The new guidelines also decrease the reporting requirements for resident physicians whose workloads exceed the allowable limits.
“As the national union representing resident physicians, we are obligated to speak out when the safety our patients and the well-being of resident physicians are in danger,” said CIR President Dr. Eve Kellner. The ACGME states that ‘The American public deserves to know that starting on Day One, physicians in practice already have the real-world experience they need to ensure high-quality patient care.’ Does the public also not have the right to know that their physicians are sufficiently well-rested and have had enough time off to attend to their basic needs, study complex cases, and build a sustainable practice?”
According to the new guidelines, all residents will now be allowed to work up to 28 consecutive hours twice a week. If residents stay beyond 28 hours after hand off for a special circumstance, they are no longer required to document their reasons for doing so, nor are programs required to review and track any such episodes.
The ACGME’s revised program requirements now include hours worked at home or spent on “home call” within the 80 hour per week limit, but how that will be documented is unclear. The ACGME has actually removed the word “honest” from the language stating that residents must report accurately on hours, patient outcomes, and clinical experience. With patient lives in doctors’ hands, reporting must not only be accurate, but also honest.
We are glad to see that the ACGME recognizes the problems with “routine reliance on residents to fulfill non-physician obligations,” as this remains a major driver of excessive work hours. We look forward to seeing survey questions or other instruments that explicitly assess this issue as it remains a major driver of excessive hours.
Finally, the requirement that residents be allowed time off for medical, dental and mental health appointments, is a positive change, along with 24/7 access to confidential mental health counseling.
Unfortunately, we worry that these measures will do little to improve resident well-being in the long term if 28-hour shifts and 80-plus hour weeks are the norm. As sleep scientists Dr. Chris Langrigan and Dr. Charles Czeisler documented in a recent Washington Post article, shifts longer than 24 hours lead to a 72 percent increase in the risk of needlestick injuries and a 168 percent increase in the rate of car accidents among young doctors driving home from work. Equally troubling is the increased risk of serious medical errors.
Contact CIR to let us know how the changes to duty hours protections will affect you: firstname.lastname@example.org.
To read a summary of CIR’s March 2016 recommendations to the ACGME, visit https://www.cirseiu.org/cirs-position-on-patient-resident-safety-in-2016/