A new proposal from the Accreditation Council for Graduate Medical Education (ACGME) is seeking to increase the limit of consecutive hours that first-year medical residents can work from the current 16 to a total of 28.
At face value, it might seem like this proposal would do little to help with a resident’s already exhausting schedule and demands. There are already many mixed feelings and polarized opinions as to how such a proposal will play out in an actual clinical setting.
Weighing in on the New Proposal
In a recent statement, Michael Carome, MD, director of Public Citizen’s Health Research Group expressed a firm stance on the proposal:
“Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients, and the public. It’s disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health.”
While it is understandable how increasing the limit of hours one can work might seem to suggest that people will be overworked and held to a more rigid schedule, others believe that the opposite is true.
According to Stan Kozakowski, MD, director of the AAFP’s medical education division in a MedPage Today interview:
“The 24 hours (not including 4 hours for transition time) allows greater flexibility, so if the work is completed, one could leave at whatever the appropriate time is, and the resident is not locked into a 16-hour shift.”
Notably, Dr. Kozakowski went on to mention previous surveys regarding the institution of a 16-hour limit back in 2011. Findings indicated that for first-year residents, quality of life increased while everyone else in training had to pick up the remaining slack.
Making Time For New Requirements
This new proposal comes as a part of the ACGME’s periodic review and revision of the common program requirements for residency programs. The task force responsible for examining the current section VI of these requirements is putting emphasis on professionalism, empathy, and personal commitment rather than unrealistic conditions and time requirements.
In an open letter to the graduate medical education community, Thomas Nasca, MD, chief executive officer of the ACGME and vice-chair of the task force stated the following:
“It is important to note that the absence of a common 16-hour limit does not imply that programs may no longer configure their clinical schedules in 16-hour increments if that is the preferred option for a given setting or clinical context. No action is required by programs that choose to continue this configuration.”
Additionally, the ACGME has taken into consideration the fact that specialties like anesthesiology, emergency medicine, and internal medicine which already impose more restrictive shift limits should and will likely continue to do so.
The goal is that with fewer hand-offs and transitions taking place in clinical settings, patients will receive a more consistent level of care, with medical personnel having the choice to continue attending to the given situation without being required to clock out at an inconvenient time. The new proposal will be available for a total of 45 days to be reviewed by the public after which the task force will review comments and provide its final proposed requirements.