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ACGME Proposal Loosens Resident Scheduling Rules
Developing
In Short: At issue is whether loosening restrictions on resident work hours will improve training and patient care or exacerbate fatigue, burnout, and patient safety.
The Accreditation Council for Graduate Medical Education (ACGME) has proposed changes to the work-hour requirements for medical residents, aiming to provide programs with greater scheduling flexibility while maintaining the 80-hour average workweek limit.
According to an ACGME spokesperson, the updates are intended to support high-quality education and patient safety while offering more flexibility to residency programs.
Daniel Counihan, MD, a general surgery resident at Boston Medical Center, expressed concern that the proposed changes could reduce the already limited recovery periods for residents.
Specifically, the ACGME proposal would eliminate the 8-hour rest requirement between shifts and shorten the mandatory time off after 24 hours of in-house call from 14 hours to 12 hours.
Stakeholder feedback showed strong support for maintaining the 80-hour weekly limit, with many advocating for greater flexibility to better prepare residents for independent practice and preserve continuity of patient care.
The proposed revisions could be the most significant since ACGME instituted the 80-hour average workweek for residents in 2003, intensifying long-standing concerns about health and wellness protections for trainee physicians.
Naveena Daram, MD, who recently completed an ob/gyn residency, questioned the rationale behind removing protections for a vulnerable group of people in order to ease scheduling.
What this adds
The ACGME proposal has intensified concerns about the health and wellness protections for trainee physicians.
What's still developing
- Counihan, who is on the bargaining team of his resident’s union and involved in active contract negotiations, said the proposed changes could cut into an already limited recovery period.
- The 80-hour average weekly maximum, 1 day free in 7, and the cap of 24 consecutive hours plus 4 hours for patient-safety activities make it “nearly impossible” for a program to assign residents in-house call more frequently than every third night on average, the document said.
- At issue: will loosening restrictions on resident work hours improve training and patient care — or worsen fatigue, burnout, and patient safety?
- However, when averaged over 4 weeks, that intense workload remained within ACGME guidelines.