Shorter work hours are approved for rookie doctors

[September 30, 2010]  CHICAGO (AP) -- Rookie doctors will be getting shorter work shifts, along with stricter supervision, but a medical student group said Wednesday that the changes don't do enough to protect sleep-deprived residents and their patients.

The Accreditation Council for Graduate Medical Education's board of directors approved new rules on Tuesday for more than 110,000 new doctors being trained at U.S. hospitals. The idea is to improve patient safety and reduce medical errors caused by junior doctors working extremely long hours.

The biggest change affects interns -- new doctors in their first year of medical residency. Their work shift limit is being cut from 24 hours to 16 hours, and "strategic napping" is strongly recommended. The maximum shift length remains 24 hours for residents in their second year of training and beyond.

Also, medical residents are to tell patients they're being supervised by more experienced physicians, and the hierarchy should be spelled out to patients, the rules say.

The revisions "will require small change in some programs and large changes in others, all with the goals of ensuring patient safety, that the next generations of physicians are well-trained to serve the public and that residents receive their training in a humanistic learning environment," Dr. Thomas Nasca, CEO of the accrediting group, said in a statement.

The American Medical Student Association had sought substantial across-the-board work-hour reductions and argues that there's no reason to give first-year residents a break but not others. The medical student group, joined by other advocacy groups, earlier this month asked the government's Occupational Safety & Health Administration to look into work hours for doctors-in-training.

"We're going to keep pushing" for stronger limits "because it involves both patient safety and our safety and well-being," Sonia Lazreg, the group's health justice fellow, told The Associated Press. "The fight for safer work hours is not over."

The new rules also strengthen supervisory requirements and include an entire page about the types of close supervision first-year residents should receive. The rules also explain that residents must demonstrate specific skills before being given more responsibilities.

The previous rules had only one sentence about supervision standards, Nasca said.

Lazreg said the rules mostly mirror a draft proposal outlined in June, but with one important change. The draft said second-year residents and beyond could be on call only one in every three nights. The final rules say that can be averaged over four weeks, which she said weakens the provision.

"It means you could be on call every other night, developing chronic sleep deprivation, as long as it averages out," Lazreg said.

OSHA head David Michaels said the agency is considering the groups' petition. He stressed that hospitals and medical training programs are not exempt from laws ensuring that employees' health and safety are protected.

In a statement to the AP, he said the agency "is very concerned about long work hours, fatigue and safety, not just for medical residents, but for all workers. It is clear that long work hours can lead to tragic mistakes, endangering workers and the public."

"With respect to medical residents, we know of evidence linking sleep deprivation with an increased risk of needle sticks, lacerations, medical errors and motor vehicle accidents," Michaels said.

John Nylen, the accrediting council's chief operating officer, said the new rules are based on thorough research, with input from residents and the medical community. The revisions protect patients, residents and medical educational opportunities, he said.

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Online:

Accrediting council: http://www.acgme.org/

Medical students group: http://www.amsa.org/

[Associated Press; By LINDSEY TANNER]

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