On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME) increased the limit on continuous resident hour shifts from 16 to 24 hours. Especially in the context of increasing rates of physician burnout, reactionary opposition began to spill into editorials, headlines, and podcasts. But before we break out the pitchforks, let me say that there is more than one way to view this situation.
Why It’s Bad
In 2003, the ACGME imposed shift restrictions after the premature passing of Libby Zion, an 18-year-old college student. Her death was attributed to the resident’s continuous 36-hour shift (although you can probably also argue for lack of supervision, according to the The Washington Post). In the wake of the 2017 reform, many physicians voiced their concerns about why sleep-deprived residents are a danger to both themselves and their patients.
Why It’s Good or Might Not Matter
To support the new regulations, advocates have been frequently citing the conclusion of a study from the New England Journal of Medicine on surgical residents:
In surgical settings, most studies have shown no difference or a worsening in patient postoperative outcomes and resident education after duty-hour reforms. However, many studies have suggested that duty-hour reforms resulted in improved well-being and less fatigue among surgical residents.
This finding is controversial, because we also have to weigh the scale between the health of the patient and of the resident. The study also begs the question of whether we should have shift restrictions at all. Additionally, Johns Hopkins researchers argue that shorter shift times lead to an increased number of handoffs, which jeopardizes patient safety.
Of course, we still need to consider other factors. For example: specialty, location of practice, hospital/clinic bureaucracy, and individual expectations (e.g. I need time for naps daily…emphasis on “need”). These all chip at the balance between physician competence and patient safety. More studies and other means of evidence-based input are needed to better gauge the repercussions of instituting the reform (or removing it completely) on residents of different fields, their colleagues – including nurses, PAs, and others – and patients.
Categories: In Training