ACGME reverses policy: First-year doctors can work 24-hour shifts starting in July

Doctor time
The ACGME will allow first-year doctors to work longer shifts starting July 1.

In a reversal of policy, the Accreditation Council for Graduate Medical Education (ACGME) announced today that it will allow first-year doctors to work 24-hour shifts in hospitals starting July 1.

Despite opposition from some medical residents, the controversial change was among a set of revisions to the standards for all U.S. residency and fellowship programs released (PDF) by the organization that oversees doctors’ training. It lifts a requirement that limited first-year physicians to 16 consecutive hours of patient care.

While opponents said the change would jeopardize patient safety by putting new, sleep-deprived doctors in charge of patients, the ACGME said returning first-year residents to the same schedule as other residents and fellows will allow for better team-based care and seamless continuity of care with fewer handoffs of patients between doctors.

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“The updated requirements place greater emphasis on the elements of training that most directly impact patient care,” said Anai Kothari, M.D., general surgery resident at Loyola University Medical Center and resident member of a task force that studied the issue, in the announcement. “Bolstering requirements in the areas of supervision, professionalism and team-based care will allow residents to train in environments that maximize patient safety both now and in the future.”

In a tweet, Public Citizen, a consumer group that opposed lifting the cap, called it a “dangerous decision.”

“Fourth-year medical students across the country are now bracing themselves for inhuman shifts that will require them, just after graduating from medical school, to make life-or-death medical decisions and to drive home while sleep-deprived for 28 hours or longer,” said Michael Carome, M.D., who heads the organization’s health research group. “The ACGME’s adoption of this dangerous proposal displays a reckless disregard for the lives and health of thousands of medical residents and their patients nationwide.” A survey conducted by the group last year found the change is opposed by the vast majority of the American public. 

The ACGME took the action despite the delivery last month of a petition with 67,000 signatures asking its directors not to increase the hours for new medical residents, saying it would be dangerous for new doctors and their patients.

Starting with the new academic year, the cap for first-year residents will increase to 24 hours, plus up to four hours to manage care transitions. The revised standards do not change the total number of hours per week that first-year residents work.

At the same time it increased the work hours for first-year doctors, the ACGME said its new requirements, detailed in a memo (PDF), recognize the significant risk of burnout and depression for physicians. For the first time, the requirements make both residency programs and institutions responsible for prioritizing physician well-being, ensuring protected time with patients, minimizing nonphysician obligations, and ensuring that residents have the opportunity to access medical and dental care, according to the ACGME announcement.

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