National Poll Shows Broad Support to Limiting Work Hours of Physicians in Training
Monday, September 19, 2016
A new national poll shows that the vast majority of the American public favors restricting the work shifts of medical residents to no more than 16 straight hours without sleep. A majority of the public—86%—is opposed to lifting the 16-hour cap for first-year residents, and 80% of the public supports implementing the 16-hour cap for all residents, not just first-year residents.
The poll was commissioned by Public Citizen, a nonprofit advocacy organization, and released on September 13, 2016.
Work hours for medical residents are set by the Accreditation Council for Graduate Medical Education (ACGME). In 2011, responding to strong evidence that patients and residents are at risk of harm when residents are sleep deprived, ACGME set a limit of 16 straight hours for first-year residents, and up to 28 hours for other residents. Even so, some physician organizations have lobbied to relax the rules, claiming that limits to work hours impact the educational experience and lead to more frequent “handoffs” (that is, when a resident who is ending his or her shift hands off the patient to another).
By request of some physician and surgeon organizations, ACGME relaxed limits for purposes of research, allowing first-year residents to work up to 28 hours or more. The FIRST trial, which looked at surgical residents, found no significant difference in outcomes when residents worked beyond the duty hour restrictions. The iCOMPARE trial is studying work hours among internal medicine trainees and has not yet reported its results. Yet the trials themselves have been criticized for not sufficiently allowing for informed consent of the trainees or the patients they are treating and for potentially putting patients at risk.
Earlier this year, the ACGME invited interested groups to provide testimony regarding a potential relaxing of duty hour restrictions. The National Patient Safety Foundation joined with other concerned groups in advocating for the current limits to stand, with greater emphasis, for example, on implementation of practices that have been shown to ensure safer handoffs.
“We should not settle for care that is ‘no worse,’” said Patricia McGaffigan, RN, MS, chief operating officer and senior vice president for program strategy and management at NPSF. “We should not have to choose between patient and workforce safety. We need to come together as a community to learn how to optimize patient and workforce safety.”
Fatigue is in fact an issue that is affecting health care workers in all disciplines and at all levels. NPSF urges that fatigue be addressed as part of a broader march toward total systems safety in health care.
Read the press release from Public Citizen.
Read the National Patient Safety Foundation’s testimony to ACGME.