ACGME Hour Changes Should Reflect Our Reality

December 13, 2016

By: Committee of Interns and Residents

On Nov. 29 and Dec. 1 the ACGME held a symposium on physician well-being, focusing on solutions to the epidemic of burnout, depression and suicide among physicians. Over a third of residents experience significant depressive symptoms, according to studies published this year in both Academic Medicine and JAMA. Many more medical students and residents are stressed and burned out, struggling with heavy workloads and not enough time for family and friends.

Given this harsh reality, many find it contradictory that the ACGME is proposing to weaken duty hour regulations. As CIR Northern California VP Josie Valenzuela put it,

“The AGGME says the evidence for worsening patient care in regards to sleep deprivation is equivocal, but any resident can tell you this is the case; just because you didn’t administer a harmful medication in error or cut the wrong vessel in surgery, doesn’t mean you are as attentive at hour 27 as at hour 2. No one seems to be addressing the impact of sleep deprivation, long hours, and circadian disruption has on wellness.”

The ACGME’s proposal would extend intern on-call shifts another 12 hours (from 16 to 24 + 4) and allow new flexibility in the rules so that all residents can stay longer than their 28-hour shift without the need to explain why. The ACGME’s proposals also put the burden solely on residents to identify when we are fatigued or impaired and do little to guarantee adequate staffing or safe workloads.

This is an issue that the national housestaff union, the Committee of Interns and Residents, has been working collaborating with AMSA on for decades. We must have a seat at the table in the decisions that affect our lives and safety. Our firsthand experience delivering patient care should be weighed very seriously if the goal is to improve both physician training AND patient safety.

CIR has called on the ACGME to:

– Guarantee residents a minimum of 5 days off per month with no averaging, and including one full weekend off.
– Ensure teaching hospitals provide adequate ancillary service staffing.
– Establish safe and sustainable resident workloads.
– Collect concrete data on resident car crashes, needlestick injuries and burnout as part of each institution’s Clinical Learning Environment Review (CLER) visit.
– Highlight the medical educator innovators who have already made significant changes to improve patient safety, resident learning, and satisfaction.
– Maintain the current duty hour limits.
– Work to redesign clinical training in fewer hours, improve the educational value of those hours, and guarantee the safety and well-being of the residents who are working them.

The ACGME is accepting public comments on their proposed regulations until December 19, and CIR will be submitting a formal comment within this time. If you would like to submit your own individual comment, you can do so here.