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How the public responded to the 2017 ACGME resident-hour restriction changes
The 2003 Accreditation Council for Graduate Medical Education (ACGME) hour restrictions impacts many residents practicing today. As interns, these rules spared the sleepless nights of around the clock rounds, post-op checks, and rapid responses. Countless media reports, studies, and lounge conversations since inception could not statistically provide any evidence to support or refute either point.
On July 1, 2017, ACGME relaxed hour restrictions for residents, allowing interns to work 24-hour shifts while preserving the 80-hour work week and one day off per week. The Libby Zion case of 1984 thrust the issue of resident work hours into the public spotlight. The untimely death of a young woman, whose chief doctors had been medical residents covering dozens of patients and receiving relatively little supervision in a New York City hospital, demanded action — the 80-hour work week.
Since the ACGME’s modification in 2017, how has the media reacted?
A collaborative group from New York City sought the answer to this question, publishing their results in this month’s JACR®. The researchers designed a series of search terms and limited their time interval to the four weeks which follows the ACGME announcement on March 10, 2017. Each article was reviewed to assess the position as favorable or unfavorable along with additional characteristics.
Most articles on this topic printed in the first week (~80%) with 36 percent of total stories expressing an unfavorable tone to the change. The study most cited by unfavorable stories was the intern sleep and patient safety study. To note, only 38 percent of unfavorable news reports cited any study. The other 62 percent used anecdotal and quotes by physicians, mostly residents.
The group acknowledges the inherent limitations of their study design, notably the quality of the search terms and news articles. There is no question that capturing the entire breadth of online media stories using a few search terms is not feasible. However, given the small sample, the results provide a useful, global opinion likely to manifest with a larger pool of news stories.
The predominant conclusion from the study expresses that the public views relaxed duty restrictions as unfavorable while the medical community approaches these changes from a neutral tone. Nonetheless, the agreed opinion realizes the need for continued research in this field, as well as outreach to the public to convey this message.
Residents will continue to feel the strain of longer hours, especially advancing from junior to senior roles. Without doubt, our attendings continue to feel this strain. Physician burnout post-residency is an often-discussed topic in the literature, though seldom spoken of at the workstation.
The public demands precision in their care without flaw or mishap and will not shy away from holding a magnifying lens to our eyes looking for signs of fatigue. Identifying the balance between professional and personal life is key to mitigating this long-term threat. As residents we can, and should, vocalize these concerns to garner the support from our ACGME office to provide support of our personal health.
By Michael Chorney, MD
- Zhang, Zi et al. The Media Response to the ACGME’s 2017 Relaxed Resident Duty-Hour Restrictions. J Am Coll Radiol 2018;15(3):452- 457.