Medical Interns Could Work Longer Without A Break Under New Rule

For years, medical interns have been limited to working no more than 16 hours without a break to minimize the chances they would make mistakes while fatigued. But that restriction could soon be eased.

The group that sets the rules for medical residents proposed scrapping the 16-hour limit for interns, doctors in their first year of on-the-job training after finishing medical school. The new rule would let these new doctors work for as many as 28 hours at a stretch.

The Accreditation Council for Graduate Medical Education proposed the change based on research that found that the relaxed rule wouldn't increase risks for patients, officials say. In fact, the ACGME says, the longer work hours could make patient care safer and would also improve medical training by giving young doctors more realistic experience.

"Just as drivers learn to drive under supervision in real life on the road, residents must prepare in real patient-care settings for the situations they will encounter after graduation," said Dr. Thomas Nasca, ACGME's chief executive officer, in a written statement announcing the proposed change.

The longer shifts could improve patient care by minimizing the number of times interns have to pass their patients onto someone else to continue their treatment, the council says. Mistakes can occur as a result of those hand-offs, the group says.

The new rules would limit interns to working no more than 24 hours at a stretch plus four hours to "manage transitions in care, promoting professionalism, empathy and commitment," according to the announcement.

"Training to become a practicing physician can be compared to training for a marathon," Nasca says. "You must learn how to pace yourself, take care of yourself and recognize your limits."

But the proposal is controversial. Critics argue it would be put patient safety at risk because the first-year residents would become too fatigued.

"Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public," says Dr. Michael Carome, director of Public Citizen's Health Research Group. "It's disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health."

The rules will continue to limit interns to working no more than 80 hours per week averaged over four weeks.

Some specialties, such as emergency medicine, anesthesiology and internal medicine, would continue to have more restrictive rules, according to ACGME.

The group will take public comments on the proposal for 45 days before making any changes final.