In July, novice doctors-in-training again will be permitted to work 28 hours straight instead of the current limit of 16, the latest turn in a long-running debate over whether sleep-deprived doctors can care properly for patients.
The Chicago-based council that accredits physician-education programs on Friday announced the elimination of the 16-hour cap for first-year medical residents, which it imposed in 2011.
The Accreditation Council for Graduate Medical Education said the longer shifts will improve continuity of patient care because there will be fewer handoffs from doctor to doctor. The change will also return first-year residents, called interns, to the same schedule as more advanced residents.
The controversial decision to allow 28 hours straight, including four hours to hand off care, relied heavily on a national study of surgical residents led by researchers in Chicago and Philadelphia. That study found longer hours did not compromise patient safety, and actually led to greater satisfaction with training among the young doctors.
Critics, including the consumer group Public Citizen and the American Medical Student Association, have called the study deeply flawed.
Diana Huang, who is about to graduate from the Lewis Katz School of Medicine at Temple University in Philadelphia, said the council's decision "seemed like a foregone conclusion, but it's still disappointing."
"As an intern, you're getting the hang of things. To be that tired and try to take care of people, even with a lot of oversight, it's a scary thing," said Huang. The Pittsburgh native, along with new graduates across the nation, will find out March 17, "Match Day," where she will do her residency in family medicine.
The potentially dangerous effects of fatigue and sleep deprivation have been at the heart of the duty hours debate since at least 1984, when an 18-year-old college student died under the care of residents at New York Hospital.
"Studies have shown that if you've been awake for more than 24 hours, it's as if you were somewhat drunk," said Michael Natter, who is graduating from the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia. "The last thing I would ever do is show up to a hospital drunk. There is also data showing that finger sticks go up [with longer hours], and residents have more car accidents when they're driving home."
Sunny Kar, a third-year resident at Rowan University School of Osteopathic Medicine in Stratford, was not subject to the 16-hour cap as an intern because osteopathic training programs maintained the 28-hour limit. He sees valid arguments on both sides.
"When you're learning, you want to spend the maximum amount of time; you want to be forever available," Kar said. "But the flip side is, fatigue is a real problem, and there are going to be more mistakes the more fatigued you are."
Anai Kothari, a third-year surgical resident who served on the council task force that evaluated residency education requirements, said the 16-hour limit forced him to miss critical moments with his patients during his first year of training.
It created "this artificial divide between upper-level and the new residents that are coming in," said Kothari, who works at Loyola University Medical Center in Chicago. "It really does fracture the team. That impacts patient safety, certainly, but it also really affects how you're educated."