Physicians Weigh in on New Rules Limiting Residents’ Work Hours

Physicians who were sleep-deprived as resident doctors have mixed feelings about rules that went into effect July 1 limiting first-year resident work hours.

Under the new rules put in place by the Accreditation Council for Graduate Medical Education (ACGME), the nonprofit organization body responsible for the accreditation of graduate medical training programs, first-year resident physicians cannot work more than 16 hours straight without a break. Specifically, they’ll be required to take a five-hour nap before working again.

But experts, physician groups, and those who have suffered losses resulting from the medical care of sleep-deprived physicians say these rules stop short of making effective changes.

In a paper published June 24 in Nature & Science of Sleep, a group of physicians and health policy experts outlined recommendations to reduce fatigue among doctors and decrease medical errors, MedPage Today reported. Among the suggestions: A cap on moonlighting during residents' off-hours; providing transportation to take residents home after a long shift if they are too fatigued to drive home safely; and eliminating much of the busy work from residents' schedules.

In the 39-page white paper, “Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety,” the authors also criticized the ACGME for not extending the 16-hour work limit to senior residents or surgical residents.

"It’s clear that policymakers, hospital administrators, and residency program directors who wish to implement safer healthcare systems must go far beyond what the ACGME will require," the authors wrote.

(Note: As of press time, the ACGME had not returned a request for comment to Physicians Practice).

Meanwhile, in perhaps one of the most moving op-ed pieces on this new rule, published July 5 by the Los Angeles Times, Lucien Leape (who happens one of the physician authors of the white paper) and Helen Haskell expressed frustration that the rule didn’t go further by implementing additional measures to assure physicians are well-rested.

“As a retired surgeon who has spent years working to improve patient safety and as a mother whose child died while under the care of a poorly supervised, exhausted intern, we are frustrated with this lack of progress,” they wrote. “The culture of medical training is attached to the idea that resident physicians must work long hours to gain experience, and it extols the virtues of the heroic, lone physician despite the proven safety of team-based care. But the evidence is clear that little learning occurs after working 16 hours.”

Other physicians, like Frederic Porcase, who has worked for more than 30 years as a family practitioner in Jacksonville, Fla., say that sometimes it is difficult to control the number of hours you work without compromising patient care.

“While I find [this rule] interesting and useful I am of the mindset that you leave when the work is done,” Porcase told Physicians Practice, via e-mail. “I am obviously concerned with those horrible [medical] errors but how many doctors have died falling asleep while driving home after being up all night taking care of their patients? The ideals that are proposed are exactly that - ideals! I don't see any one complaining about how little sleep our troops get while fighting. I generally dislike being told what's best for me. Should I only see 30 patients a day? Last week one day I saw 70. Did I want to? Are you crazy? Was I to tell them to go away that I had seen my quota and I might make a mistake? Give me a break!”

Physicians, we’d like to hear from you. How much sleep do physicians need between shifts? Did the ACGME go far enough? Post your reply below.