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Accrediting Body Should Not Endanger Resident Doctors or Patients by Rolling Back Work Hour Requirements

Dec. 15, 2016

Accrediting Body Should Not Endanger Resident Doctors or Patients by Rolling Back Work Hour Requirements

New Proposal Allows First-Year Resident Physicians to Work 28-Hour or Longer Shifts; Removes a Number of Other Protective Work-Hour Limits

WASHINGTON, D.C. – In order to protect resident doctors and patients, the 16-hour shift cap on first-year medical residents should not be lifted, Public Citizen said in comments submitted today to the Accreditation Council for Graduate Medical Education (ACGME).

Under intense pressure from dozens of physician organizations, a task force of the ACGME − the private organization that sets the rules on resident work hours that are intended to protect the health and safety of both medical residents and patients – issued a proposal to eliminate the current 16-hour shift cap for first-year medical residents and allow them to work 28 or more hours in a row without sleep. The deadline for filing public comments on the proposal is Monday, Dec. 19.

The proposal comes despite long-standing evidence that medical residents (also known as resident physicians) commit more serious medical errors when working shifts of longer than 16 consecutive hours. Residents forced to stay awake for more than 16 consecutive hours also are personally at increased risk for needle-stick injuries, motor vehicle accidents and depression.

Public Citizen strongly objects to the lifting of the 16-hour shift cap and a number of other dangerous changes in the rules including:

  • All residents would be permitted to work beyond even the 28-hour shift limit without sleep, without needing to document their reasons for doing so;
  • Residents would no longer have any minimum time off after shifts of up to 24 hours; and
  • Residents would be permitted to work more than six consecutive night shifts.

“Medical residents are not superhuman and, when sleep-deprived, put themselves, their patients and others in harm’s way,” said Dr. Michael Carome, director of Public Citizen’s Health Research Group. “The ACGME must reject this proposal in the interest of both resident and patient safety.”

The proposal is peppered with language purportedly advocating for the well-being and health of residents through a litany of vague suggestions and unenforceable mandates. In sharp contrast to this rhetoric, all of the proposal’s substantive provisions extending the consecutive hours residents can be forced to work would threaten the residents’ health and lives.

Public Citizen also pointed out that the ACGME does not systematically enforce any of its work-hour requirements. Residents self-report their hours to their programs, but these reports are not routinely inspected by the ACGME, with studies showing high rates of falsification of reported hours. With virtually no enforcement, residents and their programs will continue to violate even these new, laxer work-hour standards.

The proposal also flies in the face of the strong preferences of patients and prospective patients. A national poll, commissioned by Public Citizen and conducted by Lake Research Partners last summer, showed that the vast majority of the American public favors restricting the work shifts of medical residents to no more than 16 straight hours without sleep. Importantly, 86 percent of the public is opposed to lifting the 16-hour cap for first-year residents. Moreover, 80 percent of the public supports implementing the 16-hour cap for all residents, not just first-year residents.

In addition to Public Citizen, a number of other organizations have objected to the elimination of the 16-hour shift limit for first-year residents. These include the American Medical Student Association, the Service Employees International Union – Committee on Interns and Residents, the National Physicians Alliance, and Consumers Union.

The ACGME will now consider the task force’s proposal and is expected to finalize the requirements within the next few months. The new requirements would take effect at the beginning of the next residency academic year (July 2017).

Read Public Citizen’s comments on the ACGME task force’s proposal.

The ACGME is taking public comments on the proposal until Monday, Dec. 19.

See a video of former resident Stephanie Waggel, MD, talking about her experience working dangerously long shifts.