Longer Shifts for First-Year Residents to Start in July

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March 10, 2017

Residency programs can increase shift hours for first-year trainees beginning this July from 16 to 24, with an extra 4 hours to manage patient hand-offs, the Accreditation Council for Graduate Medical Education (ACGME) announced today.

As a result, first-year residents can have shifts as long as more senior residents. However, the maximum number of hours that any resident can log per week remains at 80.

The ACGME states that the new standard, in the making since 2015, will improve continuity of care for patients, clinical teamwork, and the learning experience for residents. However, critics of the policy, which include the American Medical Student Association and the consumer watchdog group Public Citizen, contend that longer shifts for rookie residents increase the odds of sleep deprivation and accidents, putting patients as well as physicians in harm's way.

The decision by the ACGME to relax limits on shifts for first-year residents comes at a time when the problem of physician burnout and suicide is gripping the profession. However, stress doesn't correlate necessarily to hours on the job, said Rowen Zetterman, MD, who co-chaired the ACGME task force that developed the new standard. Residents in emergency medicine are confined to 12-hour shifts but nevertheless experience high levels of burnout, Dr Zetterman told Medscape Medical News.

Dr Zetterman, associate vice chancellor for planning at the University of Nebraska in Omaha, said that the new shift limits for first-year residents are just one part of new ACGME requirements that place a greater emphasis on trainee well-being and safety. For one thing, residency program directors and other members of the clinical team need to monitor residents for signs of depression and burnout.

The ACGME says that its decision to let first-resident residents work longer hours is evidenced-based. It points to a study published in the New England Journal of Medicine in February 2016 that found that longer shifts and less rest in between for first-year surgical residents did not affect the rate of serious complications or surgical fatalities. And they were no more dissatisfied with their overall well-being than peers whose shifts were shorter.

Other recent research, however, continues to raise yellow flags about residency work hours. A study appearing last December in the Journal of the American Medical Association reported that almost 20% of general surgery residents don't complete their programs, with one of the top two reasons being an "uncontrollable lifestyle." And according to a study published last June in the Journal of the American College of Surgeons, more than two thirds of general surgery residents in a national survey met the criteria for burnout. Longer hours helped explain why some residents were likely to qualify as burned out. However, the study found high burnout rates "despite the majority of respondents adhering to work hour limitations."

Follow Robert Lowes on Twitter @LowesRobert

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