Advocacy groups call for immediate end to 30-hour shifts for new docs

Two advocacy groups call for an immediate halt to new programs experimenting with the return of the marathon, 30-plus hour work shifts for novice doctors.

The consumer advocacy group Public Citizen and the American Medical Students Association (AMSA) asked the federal government to intervene and put a stop to the practice, The Washington Post reported. They claim the long shifts pose serious health risks to student doctors as well as patients. 

The two groups have appealed to the Department of Health and Human Services (DHHS), the National Institute of Health, the Accreditation Council for Graduate Medical Education (ACGME) and the Office for Human Research Protections in the matter, according to the article. They claim the trials violated ethical boundaries because neither the physicians nor the patients they treat have any choice in the matter.

"Substantial evidence shows that sleep deprivation due to excessively long work shifts increases the risk of motor vehicle accidents, needle-stick injuries and exposure to blood-borne pathogens and depression in medical residents," said a statement from Public Citizen. "It also exposes their patients to an increased risk of medical errors, sometimes leading to patient injuries and deaths."

Since 2011, physicians and residents have been restricted to a 16-hour maximum shift length. Some physicians and healthcare administrators have chafed at the regulations, which they say needlessly complicate patient care with excessive handovers. Furthermore, shorter shifts for physicians means healthcare institutions must spend more on labor.

Two new teaching programs--the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial and the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCompare) Trial--are returning resident physicians on pre-regulatory-style 28- and 30-hour shifts to see whether there is an impact on patient harm.

The two trials involved nearly 190 hospitals or residency training programs, including, Cleveland Clinic, Duke University Hospital, George Washington University and the UCLA Medical Center, according to the Chicago Tribune. Results from the study among surgeons will be available in February, but results from the study of internal medicine physicians are not expected until 2019, according to the Post. 

The programs exist through special dispensations from the ACGME. The advocacy groups are demanding that the organization rescinds its waivers that it granted to hospitals and residency training programs participating in the two experimental trials.

While some studies have found that the length of residents' shifts had no significant impact on patient outcomes, Public Citizen and AMSA maintain that the toll on the doctors themselves is unconscionable.

"The 2011 work-hour restrictions were put in place because of clear evidence of risk to resident physicians and were in line with the ACGME's mission to improve healthcare and advance the quality of resident physicians' education," said the groups' letter to the ACGME. "The decision to waive most of the 2011 duty-hour standards, especially those pertaining to shift length and time off between shifts, for these studies is both shocking and deeply disappointing."

To learn more:
- read the Post article
- here's the announcement with links to the letters
check out the Chicago Tribune coverage

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