Have you ever worked 24 hours straight?
Some young, aspiring doctors will soon be doing just that.
First-year medical residents will be allowed to work 24-hour shifts later this year, when a cap previously limiting shifts to 16 hours is lifted.
The Accreditation Council for Graduate Medical Education (ACGME) issued a statement saying the revisions would “return first-year residents to the same schedule as other residents and fellows” and will be implemented during the 2017-2018 academic year.
The number of clinical and educational hours for residents will remain the same with a maximum of 80 hours of work per week.
But under the new revisions first-year doctors will now be permitted to work a 24-hour shift, plus an additional four hours to help facilitate transitions between doctors.
Why the long hours?
The ACGME argues that raising the cap on hours will ensure a “seamless continuity of care.”
However, the move has sparked criticism.
“The ACGME’s adoption of this dangerous proposal displays a reckless disregard for the lives and health of thousands of medical residents and their patients nationwide,” Dr. Michael Carome, director of the Public Citizen’s Health Research Group, said in a statement.
“Fourth-year medical students across the country are now bracing themselves for inhuman shifts that will require them, just after graduating from medical school, to make life-or-death medical decisions and to drive home while sleep deprived for 28 hours or longer.”
In 2011, the ACGME capped the number of hours first-year residents could work in one shift at 16 hours.
Now, the ACGME says the hypothesized benefits of limiting first-year hours were not realized and “the disruption of team-based care and supervisory systems, has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole.”
But Dr. Kelly Thibert, president of the American Medical Student Association, says that shorter shifts don’t necessarily equate to diminished continuity of care for patients.
“One of the recurring critiques of resident work-hour restrictions is that shorter shift lengths would lead to an increase in number of handoffs and thus would lead to decreased continuity of care. This concern is valid, but the perception that shorter shifts must come at the expense of patient safety due to the increased number of handoffs is just that, a perception,” she told Healthline.
“It is not the number of transitions but rather the quality of transitions that is critical to ensuring patient safety. Even at the end of 28-hour shifts, transitions of care still occur and these come at a time when residents are more likely to leave out information they deem ‘unimportant’ as they have reached and surpassed the point of exhaustion.”
Doctors facing burnout
Dr. Eve Kellner, president of the Committee of Interns and Residents (CIR), says an 80-hour work week puts enormous pressure on residents.
“Doctors are human and humans require time to attend to the needs of life,” she told Healthline. “When you’re working an 80-hour week, you don't see your children or significant other who, in moments of despair, might be the only thing that has been staving off feeling isolated or developing depression. Not to mention how impossible it is to go to the DMV, mail a package, get laundry done, make healthy food choices, and other simple things that a human intern needs to tend to.”
Kellner says physician burnout has reached epidemic levels.
In a survey of CIR members, 62 percent felt so burned out that it had affected their work and 28 percent had fallen asleep when driving after work.
Despite the high risk of burnout, Thibert says young doctors feel obligated to keep up with the demanding schedule.
“You would be hard pressed to find an intern or resident physician who would not work these long hours for fear of retaliation. It is engrained in the profession that this is how medicine operates and should therefore continue to operate,” she told Healthline.
An exception, not the rule
In a statement, Dr. Thomas Nasca, chief executive officer of the ACGME, notes that the subject of work hours is an emotional topic both within the medical community and among the general public.
But he emphasizes that not all residents will regularly be expected to work a 24-hour shift.
“It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do,” he said.
Kellner says although in the past there has been a culture that encouraged doctors to work long hours, this doesn’t necessarily need to be the expectation going forward.
“The pressure to work excessive hours is part of the history and culture of medicine, but it is slowly changing. Residents are called residents because they used to literally live in the hospital. The norms were set by a physician workforce that was largely middle and upper class men, but residency is becoming much more diverse and inclusive. We need to realize that our own health shouldn’t suffer while we are caring for patients.”