Shorter Hours Proposed for Doctors in Training

Numerous studies have shown that a medical resident's clinical performance breaks down after 24 hours on the job, and those who pull all-night shifts are responsible for more than half of medical errors. Now, new guidelines propose shortening residents' work week.

The long hours worked by medical residents have long been a concern to both medical experts and consumer advocates. Numerous studies have shown that a resident’s clinical performance breaks down after 24 hours on the job and that residents who pull all-night shifts are responsible for more than half of adverse medical errors.

As a result, the Accreditation Council for Graduate Medical Education issued guidelines back in 2003 that limited the work week for residents to 80 hours. Some residents, the ACGME found, were routinely working 120-hour weeks.

Not everyone got on board with the limits, however. Many felt that the shorter hours would have a negative impact on the training that residents received, while consumer advocates felt that the guidelines didn’t go far enough. In response to both sides, the ACMGE has issued a new set of proposed regulations that will take effect in July of next year, if they are approved.

The new guidelines would treat residents differently according to their tenure on the job:

• First-year residents would be allowed to work no more than 16 hours in a single shift.

• Residents in their second year or above will be limited to 24-hour shifts.

Currently the limit for all residents is 30 hours. The ACMGE is also planning to beef up its enforcement efforts, conducting on-site visits to each institution to monitor compliance. Those who don’t follow the rules risk loss of accreditation.

Some critics believe that 16-hour shifts are still too long and that they would pose an increased risk of medical errors. Others point out that shorter shifts would increase the number of patient “handoffs,” which is when many preventable medical errors occur.