Home > Medical School, Medical/Health Commentary > New ACGME resident work-hour policies

New ACGME resident work-hour policies

I’m surprised that the only mention of this I’ve seen (from the ever-expanding list of medical blogs I follow on Google Reader) has been this post from Bob Wachter.  Here’s an excerpt:

And the answer is: the duty hour limits will remain 80 per week.

Yet the new regulations do call for substantial changes. For example, they:

Insist on direct, in-house attending-level supervision of interns (either at the bedside or “on site and available to provide direct supervision”)

Allow housestaff workload and autonomy to escalate as residents become more senior.

Promote the primacy of education over service in curricular decision-making.

Forbid 30-hour shifts for interns; the maximum intern shift will now be 16 hours (more senior residents can still do overnight shifts of up to 28 hours, with “strategic napping” encouraged).

I agree with Dr. Wachter’s sentiment that keeping the top line number at 80 hours is probably a good idea, though as someone who has yet to start the medical education process in earnest I ought to point out that, obviously, my opinion isn’t based on any direct experience.

I’m pleased that the ACGME resisted the pressure to cut the weekly duty hours further. In addition to the massive costs of replacing resident labor (with hospitalists or allied health professionals), I believe that lower hours would be detrimental to training: residents would be forced to pack more work into less time, shorter hours would further promote a run-for-the-doors mentality, we’d be stuck with even more risky handoffs, and – I know I sound like an old fogey – I worry that even good residency programs are graduating residents who aren’t ready to be practicing doctors because they haven’t cared for enough patients, exercised enough autonomy, or developed their professional compass around when it is in their patient’s interest for their physician to work while tired.

A lot of the advocacy from medical student groups and patient advocates alike for shorter resident workweeks seems to miss the point that there is a real tradeoff between “safety now and safety later,” as Wachter puts it.  This isn’t to say that a shorter workweek would be a bad policy change — though my instinct tells me that 80 is a good compromise, it’s a relatively uninformed instinct — but rather that advocates for more work hour restrictions can’t pretend that it’s a free lunch, safety-wise.

We’ll see what happens.  Hopefully the newly-shortened PGY-1 maximum shift will stick around for 5-6 years… I certainly wouldn’t complain.

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