The Accreditation Council for Graduate Medical Education (ACGME) announced on March 10 that first-year doctors will be allowed to work 24-hour shifts in hospitals starting July 1. The cap currently limiting physicians to 16 consecutive hours of patient care will now be lifted. The new standards will allow four hours to transition patients from one doctor to the next, so first-year residents could work as long as 28 straight hours, the same as more senior medical residents.
The ACGME strikingly said the change will enhance patient safety because there will be fewer handoffs from doctor to doctor. Also, the longer shifts, they say, will improve the new doctors’ training because they can follow their patients for longer periods of time, especially in the critical hours after admission.
The decision brings to light the decades-old controversy involving how to balance physician training with the safety and needs of patients. Following a study of patient safety and work rules by the Institute of Medicine, the accreditation council imposed the cap on first-year residents’ hours in 2011 and banned 30-hour shifts that some residents had been working.
The council stated that a Task Force spent 4200 hours over 18 months formulating the new requirements. The Task Force determined the hypothesized benefits associated with the reduction of first-year resident hours in 2011 were not realized. Further, the hours-cap purportedly disrupted team-based care and negatively impacted the professional education of first-year residents.
Other program requirements capping the total number of clinical and educational hours for residents and fellows were preserved, including: a maximum of 80 hours of work per week; one day free from clinical experience or education in seven; and, in-house call no more frequently than every third night.