Jennifer Rodney, MD, a fifth-year resident physician in the department of otorhinolaryngology at the University of Oklahoma Health Sciences Center in Oklahoma City, never really understood the work hours limitation on first-year interns. Under rules put in place in 2011, first-years were limited to 16-hour shifts, while other physicians could still work 24-hour shifts.
Under revised rules that went into effect July 1, 2017, that limitation was lifted and all residents can work the same number of hours.
Good, said Dr. Rodney.
“It didn’t make a whole lot of sense to have the limitation and have them have to clock out at a certain time each day,” she said. “And when July 1 hit this year, all of a sudden that rule doesn’t apply, and they have to stay until the end of the day when the patient is done being seen. That’s the thing about medicine. … You can’t go home at a certain hour. You go home when your patients are taken care of. It was just unrealistic to treat an intern differently than the rest of the residents, because they’re going to be out of that position the next year anyway.”
In the long run, the Accreditation Council for Graduate Medical Education (ACGME) agreed (see “History of Physician Work Hours,” below). Rowen Zetterman, MD, chair of ACGME’s board, said that when the hours limit was set in 2011, it was with the understanding that the threshold would be reviewed after five years. A similar review of the new rules will take place in 2022, or sooner if new evidence warrants it.
“We heard from residents who were in the middle of an operative case,” Dr. Zetterman said. “A patient that had admitted in the previous 16 hours needed an emergency operation … and 16 hours came in the middle of the case, and they were told to go home. That was clearly an issue.”
The ACGME reviewed more than 1,000 studies and, in March 2016, held a two-day conference to which it invited 60 medical groups and organizations “to testify to us about what should be done in the learning/working environment,” Dr. Zetterman said. “Of all the 60 medical organizations that were there, the majority said we needed to return to 24 hours for first-year residents,” he added. “Most of them cited the impact it had on team-based care.”
Continuity of Care
Otolaryngologist Nilesh Vasan, MD, an associate professor at the University of Oklahoma Health Sciences Center, specialist in head-and-neck oncologic surgery, and program director for his hospital’s otolaryngology–head and neck surgery residency program, said that continuity of care is a major factor in weighing out the change in work hours.