A group that accredits medical residency programs appears poised to lift caps on work hours of first-year doctors-in-training, saying young residents aren’t harming patient care by working 24 consecutive hours plus up to four more hours to transition patients to another provider. Some medical groups and physician educators have questioned whether capping first-year resident work hours at 16, which was implemented in 2011, improved patient safety and may have instead contributed to other medical errors when the care is handed off more frequently to other health professionals. But the Accreditation Council for Graduate Medical Education(ACGME) which implements such rules for doctor training programs, says capping first-year resident work hours to shorter shifts was restrictive and could hurt patient care and the quality of doctor training. ACGME wants to avoid the “disruption of team-based care and to facilitate seamless continuity of care.” For the most part, medical residents won't experience a 24-hour shift, doctors say. Dr. Tomas Nasca, ACGME’s chief executive officer said in an interview that not even half of medical specialties “ever come close to” 80 hours of residency work in a week or “working 24 consecutive hours.” But there are instances where round-the-clock care is needed, so it's important for a young resident to experience what that's like, medical educators say. Think specialties like neurosurgery and other medical disciplines where the seriousness of a patient’s injury or illness requires a physician to be working well beyond 16 hours, such as performing surgery followed by post-operative care. “At some point in their clinical practice, physicians who care for these patients will need to put in these kind of hours,” Nasca said. ACGME is seeking public comment on the proposal for the next 45 days. The council hopes to have the work-hours issue as well as other recommendations on new residency training requirements ready for medical schools and teaching hospitals to implement for the 2017-2018 academic year, which begins in July of next year. Teaching programs will still have latitude in how work hours are set up across the country. “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,” Nasca wrote to medical educators in a letter . The 24-consecutive-hour cap has been the standard for all residents from the second through the 10th year for decades, Nasca said. Thus, it shouldn’t be a stretch for teaching programs to allow for first-year residents. ACGME in 2011 imposed stricter work hours for residents including a 16-consecutive-hour cap on shifts that could be worked by first-year medical residents. There were also certain requirements regarding time off between shifts. At the time, reports said long hours contributed to medical errors and the council and graduate medical education programs across the country were under pressure from myriad forces including Congress to do something about it. Some physician groups and public health advocates say the council’s move lifting the 16-consecutive-hour cap puts first-year residents, patients and the public “at risk of serious injury [and] death,” Public Citizen said. “Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public,” Dr. Michael Carome, Public Citizen’s Health Research Group director said. “It’s disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health.” Still, Nasca said the recommendations have overwhelming support in the healthcare community. ACGM received testimony and related written statements from more than 110 medical organizations and Nasca said the “vast, vast majority were supportive of these modifications.” Source
