With the release of a report by Public Citizen today on the public’s deep concerns about extremely long work hours for resident physicians, the nation’s oldest and largest physicians’ union is renewing its appeal for commonsense reforms that will protect both residents and patients.
“The report released today by Public Citizen should give pause to everyone in the field of medicine. Now is the time to reflect on what can be done to balance the necessary rigors of residency training with our duty to provide safe, quality care for our patients,” said Dr. Eve Kellner, national president of the Committee of Interns and Residents (CIR/SEIU) and a psychiatry resident at Westchester Medical Center.
As the ACGME, the accrediting body for residency programs, is considering rolling back the hours limits imposed in 2011 on hospitals who employ first-year residents, consumer advocates are raising concerns about patient safety and transparency.
Of the 500 voters polled, an overwhelming 86 percent oppose any proposal to allow first year residents to work longer than the current 16-hour limit. A strong majority (80 percent) believe second year residents and above should also be restricted from working 28-hour call shifts. The poll has a margin of error of +/- 4 percent.
Seventy-seven percent of survey respondents said hospital patients should be informed if a medical resident treating them has been working more than 16 hours without sleep. Knowing that such a doctor was treating them would make 86 percent of voters feel anxious about the safety of their medical care and 84 percent would want to be treated by a different doctor.
“Any time our patients are feeling unsafe or anxious in our care, it is a wakeup call for organized medicine,” said Dr. Matthew Chatoor, a surgery resident at Harlem Hospital in New York and CIR regional vice president..
CIR has identified key reforms that will improve resident wellbeing and mitigate the harm to patients from exhausted residents. These recommendations were presented in a testimony before the ACGME in March 2016:
- Guarantee a minimum of 5 days off per month for residents with no averaging, and including one full weekend off.The current rules allow for 1 day off per week, averaged over 7 days, which often means residents work 14 consecutive days.
- Ensure teaching hospitals provide adequate ancillary service staffing. Many residents today still spend extra hours in the hospital each day transporting patients, tracking down labs, drawing blood, putting in IVs, or discharge planning; work which could and should be done by other staff.
- Establish safe and sustainable resident workloads, for example limits on patient admissions and the number of patients a resident must be responsible for while on call.
- Collect concrete data on resident car crashes, needlestick injuries, and burnout as part of each hospital’s s ACGME Clinical Learning Environment Review (CLER) visit.
- Mandate clinical work and learning redesign with a focus on those rotations that residents identify as the most grueling or those with the least educational value. Using the tools of quality improvement, residents can lead the way in identifying changes that will significantly improve the clinical and learning environment. Best practices exist and should be publicized so other programs can learn from them.
- Do not weaken the current duty hour limits.The ACGME should instead be examining what can be done to redesign clinical training in fewer hours, improve the educational value of those hours, and guarantee the safety and wellbeing of the residents who are working them.
“Residents constantly strive to provide the very best care to our patients, but we cannot expect to be at our best when we are acutely sleep deprived,” said Dr. Kellner. “We know the ACGME is committed to improving resident wellbeing and patient safety, and we hope that any recommended changes to work hours limits that they make will reflect that commitment.”
Please contact Heather Appel, CIR/SEIU Communications Director, at 917-886-3651 for more information or to request an interview with a CIR resident spokesperson.
Founded in 1957, the Committee of Interns and Residents (CIR/SEIU Healthcare) is the oldest and largest housestaff union in the U.S., representing more than 14,000 physicians in public and private teaching hospitals across the country. CIR empowers resident physicians to have a voice in their employment and training and to be advocates for their patients. Learn more about CIR by visiting www.cirseiu.org.