Young doctors may work longer hours
24-hour shifts urged to balance care with safety
The organization that oversees the training of young doctors recommended Friday that firstyear physicians in hospitals be allowed to work 24-hour shifts — eight hours longer than they are permitted now.
If approved in February, the proposal by a task force of the Accreditation Council for Graduate Medical Education would go into effect in July, when the next class of medical school graduates begin their “residencies” at teaching hospitals across the United States.
It is the latest development in a decades-old effort by the medical profession to balance the education of doctors with patient safety at the hands of sleep-deprived new physicians.
Improve ‘coordination’
The expanded workhour limit would align the schedules of novice physicians with those of second- and third-year doctors, who also care for hospitalized patients but are permitted to work longer hours as they advance through the training in their specialties.
The goal is to “improve the coordination of clinical care by the interns and residents in the teaching environment,” said Thomas J. Nasca, ACGME chief executive and vice chairman of the task force. First-year doctors are commonly called “interns,” and those farther along in their training are known as “residents.”
Twenty-four hour shifts, Nasca said, “is what currently exists for everyone else other than interns, and it’s what the interns did up until 2011.”
Compromised care
That year, after a study of patient safety and work hour rules by the Institute of Medicine, the ACGME prohibited first-year physicians from working more than 16 hours consecutively, with a few minor exceptions, and banned the 30-hour shifts that some trainees had been working.
But some faculty believe the work-hour limits have actually compromised patient care by increasing the frequency of patient “hand-offs” from doctor to doctor as shorter shifts end. Many teachers also believe that young doctors learn best by following a patient in the crucial first 36 hours of a hospitalization.
A study released in February showed no effect on patient outcomes when surgeons in training were allowed to work extremely long shifts. The schedules caused only minor dissatisfaction among new doctors. The results of a second study of long shifts for internal medicine trainees have not yet been released.
The American Medical Student Association, which includes doctors in the early years of their post-medical-school training, and the advocacy group Public Citizen protested the second experiment, contending it was unethical because neither patients nor doctors at the 63 participating programs were given the chance to consent to the arrangement.
The new rules recommended by the task force would retain many of the work-hour requirements currently in place. In each four-week period, residents would be limited to work weeks that average 80 hours and must be provided one day off every seven days. They could not work overnight shifts in the hospital more than once every three days.
Mental health, well-being
The 24-hour shifts could be lengthened by as much as four hours to accommodate transitions in care.
The proposal also includes new requirements that supervisors pay attention to the mental health and well-being of doctors in training. Studies have shown that burnout, depression and even suicide are on the upswing in the medical profession, Nasca said.
The new rules require that program directors teach faculty and trainees how to detect and respond to burnout, depression, substance abuse and suicidal ideation among young doctors.
The recommendations will be open to 45 days of public comment. The ACGME board is scheduled to vote on them in February.