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Proposal to Allow First-Year Resident Physicians to Work 28 Hours in a Row Puts Residents, Patients, Public at Risk of Serious Injury, Death

Americans Overwhelmingly Oppose ACGME Work-Hour Proposal

WASHINGTON, D.C. − A proposal to allow first-year medical residents to work 28 hours in a row without sleep is a dangerous step backward and, if implemented, would expose residents, their patients and the general public to the risk of serious injury and death, Public Citizen said today.

The Accreditation Council for Graduate Medical Education (ACGME) today proposed a new set of requirements for the number of hours worked by resident physicians. The proposal removes the five-year-old 16 consecutive-hour limit on first-year resident work shifts and allows them to work up to 28 hours straight without sleep, while caring for patients. The proposal comes amid intense pressure from dozens of physician groups to do away with the limit.

“Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public,” said Dr. Michael Carome, director of Public Citizen’s Health Research Group. “It’s disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health.”

The ACGME instituted the 16-hour limit for first-year residents in 2011, in response to a 2009 report by the Institute of Medicine (IOM) that, based on an exhaustive review of the evidence on the harms of long work shifts, recommended that all residents be restricted to 16 consecutive-hour shifts. The IOM’s report pointed out that tired residents are more likely to injure themselves and their patients, in addition to being at increased risk of a motor vehicle accident when driving home while sleep-deprived. The ACGME itself acknowledged at that time that interns “make more errors when working longer consecutive hours.” Five years later, although this statement still holds true, the new ACGME proposal now rejects this highest-quality evidence.

In addition to being at odds with the medical evidence, the new proposal is fundamentally opposed to the will of the American people. A public opinion poll commissioned by Public Citizen and conducted by Lake Research Partners, released 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. The results were overwhelmingly bipartisan and shared by all demographic groups. Thus, this is not a partisan political issue, but one of public safety.

Public Citizen and the American Medical Student Association, along with the Service Employees International Union’s Committee on Interns and Residents, the National Physicians AllianceConsumers Union, and dozens of patient groups and advocates have urged the ACGME to maintain the 16-hour limit for first-year residents. Public Citizen plans to mobilize these and other groups to continue to pressure the ACGME to keep the 16-hour limit in place for first-year residents – and to extend the same limit to all residents in order to protect them and their patients from further harm. This will include various actions intended to persuade the ACGME board to reject this dangerous proposal, including submitting comments during the comment period, which ends on Dec. 19. Members of the public can submit their own comments to the ACGME before the deadline.

Additional resources from Public Citizen:

  • Read Public Citizen’s report, “Bipartisan Consensus: The Public Wants Well-Rested Medical Residents to Help Ensure Safe Patient Care,” detailing the results of last summer’s public opinion poll regarding resident duty hours and summarizing the evidence on the harms of long work shifts.
  • Read the letter from Public Citizen and the American Medical Student Association to the ACGME transmitting the report.
  • See the action alert to Public Citizen’s members and supporters urging them to email ACGME CEO Dr. Thomas Nasca expressing support for maintaining the 16-hour limit for first-year residents. To date, more than 10,000 emails have been sent to Nasca.
  • Read testimonials from physicians describing personal experiences related to sleep-deprivation that occurred during their residency training.
  • Read related letters, statements and news/blog posts from other organizations expressing similar concerns regarding long resident work hours.