Half of residents disapprove of duty-hour rules

About of half (48.4 percent) of residents gave a thumbs down to the 2011 duty-hour limits under the Accreditation Council for Graduate Medical Education (ACGME) rules, despite efforts to improve patient care and resident life and education, according an article published last week in the New England Journal of Medicine.

Less than a quarter (22.9 percent) said the work-hour rules changed for the better; 28.8 said they were neutral on the regulations because their work was unchanged, according to a survey of 123 ACGME-accredited residency programs, representing more than 26,000 residents across specialties.

When the ACGME finalized rules in 2011, limiting residents to spend no longer than 16 consecutive hours in the hospital, the goal was to combat fatigue, improve resident education and keep patients safe. However, overall, 43 percent of residents said their work schedules got worse.

"[R]esidents are working the same number of hours with no change in the amount of rest they receive and with worse schedules than last year, which diminishes their overall quality of life," the study authors wrote.

The dissatisfaction also comes from the sense that the junior-level workload is being shifted to more senior residents. Although 61.8 percent of interns reported their quality of life improved during the first year, 49.7 percent of senior residents reported their quality of life got worse.

Regarding resident education, most residents believed that their training worsened under the new rules (40.8 percent) or remained unchanged (42.8 percent). Only a fraction (16.3 percent) thought their education improved.

"[R]esidents believe that a chief goal of training--preparedness for transitioning from intern to senior resident, then ultimately to attending physician--is being delayed."

Only a fifth (20.4 percent) of residents thought patient safety improved with the new duty hours because of more handoffs, reducing continuity of care and potentially harming the doctor-patient relationship, according to the study.

For more information:
- read the NEJM article
- see the data on the demographics of the survey respondents
- here's a table on survey responses on perception of ACGME rules
- check out the ACGME duty hour rules (.pdf)

Related Articles:
Wake up your zombie workforce to patient safety risks
Surgeons still tired despite duty hour limits
Long work hours linked to adverse events, Joint Commission warns
New resident duty hours to cost teaching hospitals $1.3B
New resident duty-hour limits not enough: Fatigue, errors still rampant
The 16-hour day dilemma: Will shortening residents' hours work?