Advocating for change

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) released new guidelines for resident work hours, establishing an 80-hour per week cap and one free day per week on average over 4 weeks, among other rules, to protect the residents.

There are conflicting opinions about this decision. On one hand, residents in the past worked over 100 hours per week, sometimes staying in the hospital for 36-42 hours. Because they worked longer hours, they were exposed to more cases and, after completing residency, were prepared to work independently as attending physicians. Many of those residents, now attendings, still believe that their training of >100 hours a week should be the standard. On the other hand, a 1999 survey showed that residents averaging more than 80 hours per week were more likely to be involved in a personal accident, injury, or serious conflict with other staff members (1). The Libby Zion case in 1984 (where physician fatigue was suspected to be a contributing factor to death) triggered the formation of a commission to investigate the supervision and work hours of residents in New York hospitals (2).

As healthcare professionals, it is common to prioritize our patients over ourselves. However, we should understand that our health is important too; resting is our right, and we should not feel embarrassed to ask questions about our schedule or to ask for help when feeling burnt out. Thanks to physicians willing to speak out, we have better conditions than before; speaking out is not a sign of laziness or weakness.

There is no easy solution to gaining the experience to practice independently after residency. Still, I believe that increasing the hours of duty is not one of them as a lot of the resident’s hours are used in not medical-related matters. In the United Kingdom and other Western countries, the current weekly limit for “actual work” for junior doctors is 56 hours (with an overall limit of 72 hours, including other in-hospital activities) (3). However, nobody assumes that doctors in the United Kingdom are not as prepared as those in the United States.

I am grateful for the ACGME changes. As medical burnout and mental health awareness increase, I expect more changes. It is possible that 24-hour shifts will be a thing of the past 50 years from now. We should not underestimate the influence of our voice for change, and we should never stop advocating for ourselves and for future residents. Change is possible and I hope the residents of the present are brave enough to bring any concern to the respective authorities and contribute to further improvements to the conditions for residents of the future.

Feel free to share your ideas for change in the comments.

For more information check out my resources:

1. A brief history of duty hours and resident education. ACGME (https://www.acgme.org/globalassets/pdfs/jgme-11-00-5-111.pdf).
2. Debate Over the 80-Hour Work Week. AMA journal of ethics. Virtual Mentor. 2003;5(3):84-87.
3. Fatigue among Clinicians and the Safety of Patients. The New England Journal of Medicine. October 17, 2002. N Engl J Med 2002; 347:1249-1255