As expected the ACGME has approved an increased in resident work hours.
Interns will now work shifts up to 24 hours straight. Previously shifts were capped at 16 hours.The new hours will go into effect this July.
The 80 hours/week maximum rule remains in effect.
http://www.latimes.com/nation/nationnow/la-na-rookie-doctors-work-20170310-story.html
^^ I heard this on the way home on NPR. Disconcerting 
The comments section of articles about doctors and the medical profession in general are always the most interesting part…and not always in a good way.
I think that my daughter would tell you that her first few months as an Ob/Gyn intern were the most terrifying of her life. She had a lot of responsibility and little practical knowledge. I didn’t think it was a bad idea to protect the intern year and I don’t know if the addition of 24 hour shifts would have helped her develop her skill set any faster. Now they are a normal part of her life and she knows how her body responds to them. She has a couple a month.
D1 had 24 shifts her intern year because her residency program was part of the study on increased work hours. She said you get used to them.
The data on the increase in the number of patients “falling through the cracks” is real and there has been an increase in the number of errors in patient treatment/management. There has been a lot of system failures with the shorter shifts.
D1 just had one her cases sent to M&M this year, not because of some sort of failure or mistake on her part (her tentative diagnosis was actually correct–and it was a zebra not a horse), but because the patient–and D1’s treatment orders–weren’t not followed up on after she left and the patient now suffers from permanent brain damage and a lifelong major disability.
The original change to restricted resident and medical school work hours was done for legal reasons and not due to evidence based studies. It has not led to better patient care. Quite frankly being on call does not require brilliance but a solid foundation of medical knowledge and common sense. Don’t do anything stupid is a good mantra. There are in my experience always another intern or resident or fellow or attending or nurse that can answer your question when necessary. This is especially true nowadays as everyone has a cell phone and you don’t have to go looking for people. Your cell phone is also a mini computer with lots of information. Call used to be about 36 hours every 2 to 4 days and it was the every 2 day call that caused fatigue. The downside of restricted hours is less experience for the trainees and more cost to the hospitals. Many physicians feel that recent graduates are not as good as the result of their more limited training. One should also understand that you are not that good when you finish your formal training and there is little supervision of new physicians in the work force. Takes probably another 5-10 years on your own before you get good at what you do.
I find it hilarious to read the comments sections, since no one in the general public realizes that the intern limits are only 5 years old and this revision only reverts back to the pre-2011 rules (with a few tweaks).
The thing is, the rules get written by people who aren’t residents - I was a 3rd year peds resident in 2011, and when the changes were announced, it was obvious to everyone in the room that it wasn’t going to improve patient care. I actually found some of the rules made fatigue an even bigger deal. My program already had implemented a night float system in pretty much every rotation, and in the ICU’s that meant you did between 7 and 10 nights in a row. Not ideal (but my current job as an attending has me do a week of nights 5-6x/yr), but most people, once you had made the switch it wasn’t bad being nocturnal for a stretch, and then you only had to flip on to nights once and flip back once. The 2011 rules limited consecutive nights to no more than 6, which now meant if there were 3 residents in the NICU or PICU they were doing two stretches of 5 nights…now flipping days/nights a total of 4 times which is way more problematic. For us there was definite decrease in continuity of care for our patients as well. With two teams in the NICU in the old system, one resident would end up with a set of patients for the first 20 days of the month, a second would have the other set of patients the last 20 days of the month, and the third resident would start with one set for the first 10 days, go on to nights, and then take the other set of patients the last 1/3 of the month. With the 2011 system, there was a lot more flipping between teams which is not what you want for a bunch of NICU babies that have a lot of administrative things that have to happen in additional to medical things before they go home. Things definitely got dropped at a rate that didn’t happen under the previous rules. So there was more sleep disruption and complex patients had their care compromised…no one benefits.