A proposal to roll back work hour limits for medical residents has drawn an angry response from safety advocates, who say longer hours lead to more errors, endangering the safety of both residents and the patients they care for.

28 hours with no sleep

After intense pressure from physician organizations, a task force of the Accreditation Council for Graduate Medical Education (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.

Public Citizen, one of the groups who delivered 67,000 petition signatures to the ACGME, cited a national poll it commissioned which showed that the vast majority of the American public favors restricting the work shifts of medical residents to no more than 16 hours straight 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 extending the 16-hour cap to all residents, not just first-year residents.

Injuries, accidents and depression

Public Citizen pointed to long-standing evidence that medical residents 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.

“Medical residents are dedicated and hardworking but 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 board must reject this proposal in the interest of both resident and patient safety.”

The proposal would include other changes:

  • 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 no longer would have any minimum time off after shifts of up to 24 hours; and
  • Residents would be permitted to work more than the six consecutive night shifts to which they are currently limited.

In addition to Public Citizen, other organizations have objected to the elimination of the 16-hour shift limit for first-year residents. These include AMSA, the Committee of Interns and Residents (CIR/SEIU Healthcare), the National Physicians Alliance, Consumers Union and dozens of patient, consumer, and public interest groups and advocates.

An "archaic tradition"

Dr. Kelly Thibert, AMSA national president, who will begin her residency training this summer, observed, “Extreme sleep deprivation and long hours are a holdover from the early 20th century when residents literally resided in the hospitals in which they trained. There is no reason to continue to subject medical trainees to mental and physical exhaustion for years on end, with the harm that ensues to them, their families and their patients, simply to maintain an archaic tradition.”

The ACGME board is expected to vote on the proposal within the next few weeks. The new requirements would take effect at the beginning of the next residency academic year, July 2017.