Debate simmers over medical resident work hours

Washington – Should first-year medical residents be allowed to work for up to 28 consecutive hours without sleep?

The question has stirred debate in the health care community as a proposal is considered by board members of the Accreditation Council for Graduate Medical Education. The organization has capped shifts for first-year residents at 16 hours of continuous time since 2011, but its recent proposal would permit 24 consecutive hours of work plus four hours to manage transitions in care.

The American College of Physicians praised the proposal in December as a way to streamline resident work shifts. ACGME also has advocated the revisions to eliminate the gap between first-year residents and other residents.

Some groups are skeptical about the proposal’s safety implications because they claim tired doctors are more likely to make mistakes. The latest criticism arrived Feb. 3 as the American Medical Student Association, Public Citizen and Care2 announced a petition that included more than 67,000 signatures from opponents of the proposal. The petition followed a national poll by Public Citizen that found 86 percent of respondents are against lifting the 16-hour cap for first-year residents, and 80 percent believe all medical residents should be limited to 16-hour shifts.

“Medical residents are dedicated and hardworking but not superhuman, and, when sleep-deprived, put themselves, their patients and others in harm’s way,” Michael Carome, director of Public Citizen’s Health Research Group, said in a press release. “The ACGME board must reject this proposal in the interest of both resident and patient safety.”

AMSA President Kelly Thibert echoed Carome’s comments.

“Extreme sleep deprivation and long hours are a holdover from the early 20th century when residents literally resided in the hospitals in which they trained,” Thibert said in the release. “There is no reason to continue to subject medical trainees to mental and physical exhaustion for years on end, with the harm that ensues to them, their families and their patients, simply to maintain an archaic tradition.”