Regarding “ACGME revising work-hour rules for docs” (June 21), as a physician-in-training invested deeply in my patients, I am very concerned about the inadequacies of the Accreditation Council for Graduate Medical Education's new regulations for resident work hours.
A balancing act in capping residents' hours
The independent, nonbiased Institute of Medicine issued policy recommendations in 2008 that would prevent resident fatigue and, of more importance, protect patients to whom we vowed we would do no harm. Still, the ACGME ignores most of these recommendations, pushing instead for changes that may force higher-level residents to take on an even greater workload.
Arguments made to preserve our antiquated system ignore evidence provided by the best sleep scientists and accumulated over years of research. We know that chronic sleep deprivation impairs our ability to learn and so will endanger our future patients. We also know that residents can leave a hospital so fatigued that they have the judgment and reaction time of a legally drunken driver, which endangers residents, current patients and anyone who happens to be driving when a resident is trying to get home.
If we are to progress to an evidence-based system of medicine that will save patients' lives and save us all money, the ACGME must limit shifts for all residents to 16 hours, better enforce the regulations they set, and recruit the support of the medical institutions and legislators who can contribute to positive changes.
Sonia LazregAmerican Medical Student AssociationReston, Va.
I sure wish somebody would let me put a 16-hour cap on consecutive work hours. Unfortunately, a three-doctor group doesn't have a lot of options. And even the bigger groups have to juggle time slots to maintain 24-7 coverage of hospital patients. Maybe the American public would agree not to expect medical-care nights and weekends.
S. Fitzgibbons, M.D.Texas
Having come through two years of general surgery at one of the more abusive New York programs in the 1980s, I completely agree with limiting resident hours to a level that allows for good care and learning. My concern is that since the time of my "indentured servitude," medicine has become incredibly more complex and the knowledge base has increased by orders of magnitude. The boast that "the worst thing about being on call every other night is that you miss half the good cases" does actually have a (very small) grain of truth.
Limiting the number of continuous hours and the total number of hours worked in a week has real benefits, but it does significantly impact continuity of care and the cumulative experience of the resident. The first is probably remediable with the right program, but the latter is more problematic. It could be dealt with by increasing the number of years of training, but the downsides to the individual and to the physician supply are obvious. Another remedy could be to increase subspecialization, but this would fragment care and frustrate caregivers and patients.
I don't see a real answer, but having worked in teaching programs for most of my career, I see residents now coming through who are much brighter than I was but are graduating with certainly less experience and likely less competence because of it.
Howard Landa, M.D.Pediatric Urology:Hawaii Permanente Medical GroupHonoluluChief Medical Information OfficerAlameda County Medical CenterOakland, Calif.
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