November 4, 2016
Today the ACGME released its proposal 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. At the same time, it calls for relaxing requirements for residents to report the hours they work and provides no concrete measures to address their ever-growing workloads. The ACGME proposes these changes even as a frighteningly high percentage of residents report burnout and depression. and less than three weeks before they convene a symposium to address the problem of physician well-being.
As the national union representing resident physicians, CIR is extremely concerned about the safety our patients and the well-being of resident physicians. We do not believe that the recommendations for change released by the ACGME today will improve either of those.
The public has registered its concern as well — a bipartisan poll released by Public Citizen in September revealed that more than four out of five Americans oppose any resident physician working more than 16 hours in a row without sleep.
Despite this, the ACGME is moving for first year residents to go back to working 24-hour on-call shifts with an additional four or more hours for transition and education. These shifts can be scheduled every third night – averaged over a month. All residents will still only be guaranteed four days off a month. This is not enough time away from their extremely long hours in the hospital to prevent the stress and burnout that a majority of residents report.
“There are no enforceable safeguards against the continued burden of excessive work loads — also a source of stress and burnout,” said CIR President Dr. Eve Kellner. “The ACGME’s proposals put all the responsibility on residents to stay well under conditions that scientific evidence tells us contribute to stress, burnout, depression and even suicide.”
The patient community has strongly come out in favor of safer working conditions for resident physicians yet the ACGME completely dismisses their concerns. Patients and their family members have the right to expect that the physicians caring for them are alert, awake and not exhausted or stressed from overwork.
If the academic medicine community is truly committed to resident well-being, now is the time for the ACGME to advocate for innovative work and education re-design, more resources and better staffing. We are glad to see that the ACGME recognizes the problems with “routine reliance on residents to fulfill non-physician obligations,” but there don’t appear to be any standards established or enforcement mechanisms to ensure adequate ancillary staffing.
In the press release announcing the new recommendations, ACGME CEO Dr. Thomas Nasca likens residency training to training for a marathon. Working the equivalent of a marathon — day after day and year after year– produces burned out physicians, prone to depression, lack of compassion for their patients and colleagues and, regrettably, at increased risk for committing preventable medical errors. The ACGME should be leading the effort to bring medical training into the 21st century, and that includes addressing the toxic culture of residency.
CIR plans to file a public comment within the 45-day comment period and invites resident physicians to anonymously share their experiences with 28-hour work periods at bit.ly/workhoursform.
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/