CHICAGO — Rookie doctors can work up to 24 hours straight under new work limits taking effect this summer — a move supporters say will enhance training and foes maintain will do just the opposite.
A Chicago-based group that establishes work standards for US medical school graduates has voted to eliminate a 16-hour cap for first-year residents. The Accreditation Council for Graduate Medical Education announced the move Friday as part of revisions that include reinstating the longer limit for rookies — the same maximum allowed for advanced residents.
An 80-hour per week limit for residents at all levels remains in place under the new rules.
Dr. Anai Kothari, a third-year resident on a council panel that recommended the changes, says he only occasionally works 24-hour shifts. The extra hours give him time to finish up with patients instead of being sent home in the middle of a case, said Kothari, who works at Loyola University Medical Center near Chicago.
But first-year resident Dr. Samantha Harrington thinks it will endanger the safety of residents and patients.
Harrington says her 14-hour shifts this winter at Cambridge Hospital near Boston are already plenty long. To stay awake while driving home after work, she sometimes rolls down the window to let the freezing air blast her in the face.
Harrington says the grueling hours are “based on a patriarchal hazing system,” where longtime physicians think “‘I went through it, so therefore you have to go through it too.'” She is a member of the Committee of Interns and Residents, a union group that opposes the work-shift changes. So does the American Medical Student Association.
Dr. Kelly Thibert, the group’s president, says putting a 16-hour cap on all residents’ work shifts would be a safer way to even the playing field.
There are more than 120,000 US doctors-in-training including rookies.
The accreditation council has for years wrestled with ensuring that doctors are adequately trained but not overworked.
The 1984 death of an 18-year-old college student in a New York hospital while under the care of medical residents working long hours put a national spotlight on the issue. Medication error and inadequate supervision were cited in that case, which prompted a lengthy investigation and state limits for residents’ work hours.
In 2003, the council implemented national standards that established the 24-hour shift cap and 80-hour work week for all residents. After an Institute of Medicine report raised additional safety concerns about sleep-deprived residents, the council in 2010 shortened work shift caps for first-year residents to 16 hours and strongly recommended “strategic napping.”
Critics of the shorter limit said it short-changed rookie doctors. Dr. Karl Bilimoria, a Northwestern University surgery professor, said some residents have complained that they’ve had to leave work in the middle of surgeries.
Bilimoria led a study published last year suggesting that first-year residents could work longer without endangering patient safety or their own well-being. The research was among published findings that helped persuade panel to recommend lifting the 16-hour cap. The council’s board approved the recommendation in a vote last month. The group delayed announcing the vote until its annual education conference, which ends Sunday in Orlando, Fla.
“We all agree that nobody wants tired physicians” said Dr. Rowen Zetterman, board chairman.
He said the new rules give training programs more flexibility, help eliminate abrupt handoffs of patients and will enhance teamwork among new doctors and their supervisors. The rules say rookie doctors must have supervisors nearby, and those more experienced doctors can step in if a new resident is exhausted, Zetterman said.
US doctor training generally includes an undergraduate science-related degree followed by four years of medical school. After that, newly minted doctors pursue several years of on-the-job training as medical residents, usually in hospitals. Fellowships or extra training in medical specialties may follow after that.
— Lindsey Tanner
What is the goal here? Why are they doing this? The answer is simple. It is NOT about patient care, health outcomes. It is about what health care has been since we privatized our health care system. It is simply about MONEY. Residents get a fixed salary. No overtime. More productivity equals more money. It is WRONG.
Let’s lift the cap on aircrews, truck drivers, police and firefighters to 24 hrs. for starters. With this policy hospitals will become the 2nd leading cause of deaths in this country. What happened to common sense? I work construction and when I start making mistakes because I’m tired, I quit and go home because my mistakes cost me money.
From about the age of 6, I wanted to be a doctor when my classmates wanted to be firemen and policemen. Needless to say, I got a lot of reinforcement from the adults around me. While other kids were flipping burgers, I was cleaning butts in a nursing home. College got a job driving an ambulate. On call 40 hours a week, free housing, free hospital food and $150 a month which would pay fees, and books for next semester. Plenty of time to study, do papers, but I could not put off a deadline for a paper or test because you never knew when the phone would ring. After, several life threatening events, I decided to go back to being a nurses aid in the university teaching hospital. My pre med major was occupational therapy. We got cadavers in anatomy, medical courses, physiology, kinesiology, etc. I had no means to pay for medical school so therapy was my backup plan. To get a student loan back then you had to be poor. My dad was just not poor enough and spent college money to put my older sister through school and then she would help put me through school. Well, she got an MRS degree and started making babies. Long story short. I saw the life of a Resident and Intern up close and personal. Blood shot eyes, taking shortcuts, making mistakes the nurse caught and saved his ass and the patients. What’s the placement of a decimal point on a medication order? Life or Death. I also met a girl. It was a simple question to answer. Do I want to be married to a job that eliminates any kind of a ‘normal’ life or do I want to be married to that girl, Therapy pays pretty good. A recession proof profession. Married a therapist too. Double dipping financially. And I got to spend more time with my patients than the 5-10 minutes a doctor gets to make life and death decisions. I went home each night feeling I made the world a better place for somebody that day. No one can justify this change to make slaves out of Residents.