Article Review: First Year Physicians and 24-hour Shifts

This article from the Washington Post was recently brought to my attention, entitled “First-year doctors will be allowed to work 24-hour shifts, starting in July”. As stated in the title, starting in July, first-year physicians will now be allowed to work 24-hour shifts. The article goes into detail with many pros and cons regarding the lift of the original cap that physicians were only allowed to work up to 16-hour shifts. One of the main benefits to this new policy is as follows:

The Accreditation Council for Graduate Medical Education said the change will enhance patient safety because there will be fewer handoffs from doctor to doctor. It also said the longer shifts will improve the new doctors’ training by allowing them to follow their patients for more extended periods, especially in the critical hours after admission.

As a medical student, I can understand this benefit. As a first-year physician, I know that personally I would be eager to get involved in patient care and experience everything I possibly could. I think it’s great that physicians will be able to spend more time with their patients and have more knowledge on their care and treatment. I see first-hand in hospitals today when physicians hand off patients after a shift and there is a gap in knowledge transmitted and lots of questions left for the next physician. I do believe that this change will help enhance patient safety because physicians will have more exposure to their patients, and less questions will be asked pertaining to their care.

However – as the next point states – I feel that this new policy might possibly compromise physician safety and well-being in the long run.

Michael Carome, a doctor who heads Public Citizen’s health research group, called the move a dangerous step backwards. “We know from extensive research, multiple studies, that sleep-deprived residents are a danger to themselves, their patients and the public,” Carome said. Sleep-deprived residents are at greater risk of car accidents, needle-stick injuries and depression, the organization contends. In recent years, the medical profession has acknowledged the high rate of burnout and depression among physicians overall.

The point mentioned above is a reason that I am worried for this new change. Physician burnout is prevalent and I feel that 24-hour shifts will contribute to burnout over a long period of time. My concern is not short-term; it is long-term. I worry that this change will cause physician burnout at a higher rate within a shorter amount of time. As I read further in the article, there were some work rules that were to be implemented alongside this change that reassured me a little:

Other work rules were retained in the council’s latest review. Residents are not allowed to work more than an average of 80 hours weekly, must have one day off every seven days and cannot work overnight in the hospital more than one night in three. The new standards require hospitals and residency programs to give residents time off for their own physical and mental health appointments. The institutions also must provide ways to foster young doctors’ well-being, fight burnout and mitigate fatigue.

This is a tricky subject to review because of all the “fine print” and gray areas. I appreciate that these guidelines above will be implemented alongside the policy because there has to be limitations established to prevent physician burnout. I am interested to see how this plays out starting in July and how future physicians will be affected. I encourage all medical students to take a look at the article above and do research on this topic, because this is something that is going to affect us within the next few years. What are your thoughts?

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