First-year residents will once again be able to work 24-hour shifts

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The Accreditation Council for Graduate Medical Education (ACGME) has revised its limits on how long first-year residents can work in a single shift, increasing it from 16 to 24 hours, matching the maximum for residents at all levels.

The revised work standards for accredited US residency and fellowship programs will take effect on July 1, 2017.

“Each specialty and subspecialty has its own unique demands and skill set requirements. Some require that physicians work for extended periods of time in order to admit, stabilize, and hand off critically-ill patients,” wrote ACGME CEO Thomas J. Nasca, MD. “The American public deserves to know that starting on Day One, physicians in practice already have the real-world experience they need to ensure high-quality patient care. Residents and fellows also have the right to develop such experience under appropriate supervision so as to manage the lifetime of demands and stress that come with the privilege of patient trust.”

Several other work requirements are staying the same for all residents: 80-hour weekly work limit, one day free from clinical experience or education in seven, and in-house calls no more frequent than every third night.

ACGME had made the change to how long first-year residents could work in a single shift in 2011, but Nasca said it only succeeded in disrupting team-based care and having a “significant negative impact” on educating rookie doctors.

“It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive,” Nasca said.

Nasca guessed the public response would likely be focused on the daily schedule, even though the weekly limit isn’t changing. He justified the switch by arguing first-year residents need to be able to work as long as more experienced physicians to become comfortable with working as part of a healthcare team.

The extra hours aren’t supported by groups like the American Medical Student Association, and some residents believe the strain could affect patients’ care and safety. Samantha Harrington, MD, a first-year resident at Cambridge Health Alliance in Massachusetts, told the Associated Press 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.’”