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n a controversial move, the national body that oversees graduate medical education is looking to end the 16-hour shift limit for first-year residents.

Under revised rules proposed Friday, the Accreditation Council for Graduate Medical Education would allow residency programs to assign first-year trainees to shifts as long as 28 hours, the current maximum for residents in later years. The proposed rules would not change the current maximum hours a resident can work per week at 80, averaged over four weeks.

The decision comes amid fierce debate over whether longer shifts compromise patient safety and expose young residents to burnout that could shorten their careers, or even end them before they get started. It didn’t take long for the council’s announcement to provoke a fiery response.

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The group Public Citizen called it a “dangerous step backward.”

“Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public,” said Dr. Michael Carome, director of Public Citizen’s health research group, said in a statement. “It’s disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health.”

The accreditation council said it opted to end the 16-hour cap, instituted in 2011, to avoid disruption of “team-based care” and ensure seamless delivery of medical services to patients.

“Training to become a practicing physician can be compared to training for a marathon,” Dr. Thomas Nasca, the accreditation council’s chief executive, said in a press statement. “You must learn how to pace yourself, take care of yourself, and recognize your limits.”

The 16-hour cap stirred considerable debate, with some arguing it helped to limit errors and prevent first-year trainees from becoming exhausted. Opponents argued that undermined the flow of work and deprived trainees of the real-world experience needed to be effective on the job.

The announcement of the revised standards on Friday triggered a 45-day comment period before the rules are adopted.

The proposed revisions are not silent on physician burnout. A new section in the rules emphasizes the need for residency programs to prioritize the well-being of physicians by allowing doctors to have protected one-on-one time and limiting their administrative workload. Currently, all residents must have at least one day off from from clinical work and education requirements every seven days. 

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  • The shorter hours are a disaster — this is a good start.
    Who said it was supposed to be easy?
    And why is it hard to prove that shorter hours are safer? Because they are not!

  • Disruption of team based care? What nonsense!! Also you can’t pace yourself, take care of yourself, etc when you have “employers” making unreasonable demands on you. This is just a way to extend cheap labor. How about compensating residents better for the amount of hours worked? I’m sure that would shorten work days rather than increase them.

  • When training for a Marathon one only risks his/her performance at the competition. Most won’t kill themselves and noone else is endangered. I think this analogy was a poor argument. Instead of longer hours you should work on better and more efficient transfer of care.

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