Saturday, April 21, 2018
Health

Rule change will lead to longer shifts for rookie doctors

The notoriously long shifts worked by freshly minted doctors are about to get even longer.

The organization that oversees physician training in the United States approved new rules last week that will let first-year doctors work 24-hour shifts in hospitals starting July 1.

They had been limited to 16 consecutive hours since 2011.

Critics have been quick to raise concerns about safety — both for the rookie doctors, known as residents, and their patients. But some physicians see the benefits of longer shifts.

"Sometimes, with the hour restrictions, we miss out on opportunities regarding patient care," said Dr. Sergio Hernandez, a first-year resident in general surgery at the University of South Florida Morsani College of Medicine. "This would give some of us in surgery exposure to experiences we wouldn't otherwise have."

Physician training doesn't end with medical school. New doctors can spend up to seven years as residents in a hospital or clinic, working under the supervision of teaching physicians.

Residency programs are known for their grueling pace. A 2016 study in the Journal of the American Medical Association found nearly one in three trainees had experienced symptoms of depression.

The 16-hour cap applied only to first-year residents. More-seasoned trainees were allowed to work up to 24 consecutive hours, plus a four-hour cushion to let different doctors transition onto a case.

Last week's decision by the Accreditation Council for Graduate Medical Education to loosen the rules does not change the total number of hours first-year doctors can work. And it doesn't mean they will all work 24-hour shifts.

"It is important to note that 24 hours is a ceiling, not a floor," Dr. Thomas Nasca, the council's CEO, wrote in a memo last week. "Residents in many specialties may never experience a 24-hour clinical work period."

Still, the change was met with controversy.

Dr. Michael Carome, of the nonprofit consumer advocacy group Public Citizen, said medical school students were now bracing themselves for "inhuman shifts" that would require them to make "life-or-death decisions" — and drive home — while physically exhausted.

"The … adoption of this dangerous proposal displays a reckless disregard for the lives and health of thousands of medical residents and their patients nationwide," he said in a statement.

But Dr. Charles Paidas, vice dean for graduate medical education at the USF medical school, said the changes were vetted over a series of months. What's more, he said, the longer shifts could improve quality by reducing the number of times patients are "handed off" among doctors.

Safety wouldn't be compromised, he said.

"People should understand that (residents) are not doing anything without supervisory presence," he said.

The USF medical school has about 80 training programs for physicians pursuing different specialties, according to its website. Each will have the option to usher in the longer shifts this summer, Paidas said.

Hernandez, the surgery resident, conceded the long hours can be a challenge. He is currently training at Tampa General Hospital, but will rotate to Moffitt Cancer Center and Bay Pines VA Healthcare System.

"Sleep deprivation is something we all get trained to manage," he said, adding that USF makes bus passes and taxi vouchers available to trainees who are too tired to drive.

But residency is like anything else, he said.

"If you really like doing it, the hours fly by."

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.



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