Docs-in-Training to Work 24-Hour Shifts Once Again

Newbies need sleep-deprived experience, midnight emergencies to become fully competent, says expert

Requiring doctors-in-training to return to longer days on the job may not sound all that compassionate — either for the med student or the patient on the receiving end of health care.

But starting July 1, first-year residents may once again care for patients for up to 24 hours at a time and work a total of 80 hours per week. And everyone stands to benefit from this change, according to Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, who is also CEO of Foxhall Cardiology PC and a regular contributor to LifeZette.

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“It’s a long time in coming,” Oskoui said. “Doctors-in-training for years have had limited patient exposure — the pendulum is swinging in the right direction.”

Back in 2011, first-year residents were limited to 16 hours on the clock per shift over concerns patient care could suffer if trainees were overly tired.

“You should be more concerned about residents who may not have [had] the exposure that they need in emergency and off-hour cases,” said one physician.

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It is that same concern — that patient care could suffer — that’s behind the Friday announcement from the Accreditation Council for Graduate Medical Education (ACGME) about doctors’ new working hours and requirements.

What’s behind the change? Studies revealed that restricting resident hours did little to make any difference in patient outcomes and experiences. What it did do, though, was limit educational opportunities for trainees and take them off cases they would have benefited from staying on and see through to resolution.

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“In the real world, you’re often called upon, especially in surgery and surgery specialties, to work off hours and with some compromise of sleep,” said Oskoui. “With the rules as they were, you didn’t get intellectually prepared to do that. With doctors, part of the tradition of having more intensive training was that you might have to go in at midnight and put in a pacemaker — and you’re expected to proceed with that with the same sort of clinical ability and judgment, whether it’s 12 midnight or 12 noon. Residents even complained they were not getting to do as much or exposed to as much surgery as they needed to in a supervised setting. So it was problematic.”

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The new rules will be reviewed on an ongoing basis. At-home work will count toward a trainee’s 80-hour maximum.

“I think this is swinging toward the mean — everyone is trying to find the right amount of enough clinical exposure yet not being abusive at the same time,” Oskoui told LifeZette. “I think that’s what they’re trying to seek out here. You should be more concerned about residents who may not have the exposure they need in emergency and off-hour cases than you should about doctors being worked too hard.”

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