What Is the Effect of ACGME Duty Hours Regulations?

Does limiting the number of hours doctors work affect patient outcome, improve safety, or affect the education of otolaryngologists? Indeed, what sort of effect are the Accreditation Council for Graduate Medical Education (ACGME) duty hour regulations having?

The answer depends on whom you ask, although the bottom line is that there still needs to be more study on the topic, including looking at whether the way duty hours are now implemented is the most effective and scientifically proven method.

Duty hour regulations were introduced in 2003 with the intent of reducing physician fatigue on the job and improving patient safety. According to the ACGME Web site (www.acgme.org ), duty hours limit resident duty hours to a maximum of 80 hours a week, including in-house calls, averaged over four weeks. Residents must be given one day off out of seven, averaged over four weeks, and cannot be scheduled for in-house call more than once every three nights, again averaged over four weeks. Furthermore, duty periods cannot last for more than 24 hours, although residents may remain on duty for six additional hours to transfer patients. It is up to individual institutions to determine how to implement the rules.

According to Christopher P. Landrigan, MD, MPH, Assistant Professor of Pediatrics and Medicine at Harvard Medical School in Boston, who has a special interest in patient safety and duty hours, while the intent of ACGME duty hours regulations are on the right track, they are not very helpful in their present state.

The ACGME changes themselves were not much of a change for most specialities. The standards require no more than 80 hours per week averaged over four weeks. This means that in practice you could have a 100-hour workweek for three weeks in a row as long as the next week was 20 hours…so it’s possible to have very long work weeks, he told ENToday in an interview.

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Figure. Current regulations still allow for shifts of up to 30 hours; however, studies show a sharp drop in performance after 12 to 16 hours.

They still allow work shifts of up to 30 hours in a row, which is a limit that’s completely not evidence-based and runs contrary to everything we know about human circadian biology and the ability to adapt to long hours, he said. Indeed, one of his own studies shows that this happens. A study of 220 residents who daily logged their hours showed that 24- to 30-hour shifts remained common.