The 36 hour shift, 100 + hour work weeks for medical interns have been gone for a while.
After the 1984 death of a college student, Libby Zion (see below), who died of a “medication error” and “lack of supervision by overworked, sleep deprived medical residents”, new rules took place in 2003 implementing a 24 hour shift and 80 work week maximum caps. However, after a report from the Institute of Medicine raised additional concerns in regards to sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) shortened the 24 hour shifts to 16 for interns, first year residents.
First year residents in medicine will have a “ceiling” of 24 hour shifts starting July 1. According the ACGME “The cap for first-year residents will return to 24 hours, a cap that has been in place nationwide for all other residents and fellows, plus up to four hours to manage necessary care transitions.According to the Accreditation Council for Graduate Medical Education, “the 16 consecutive hours of patient care cap is lifted.”
So technically an intern may work 28 hours with the inclusion of evening rounds and “hand-offs”.
The 80 hour maximum work week will still maintain in effect. Working from home WILL be included in this 80 hour work week maximum.
The new rules will also maintain the one day off per 7 days worked as well as being “on-call” no more frequent than every third night.
Moonlighting for interns will also be banned, although older residents may still continue to do so if it doesn’t interfere with their work.
Why such long shifts to begin with? The ACGME wants interns to experience the same challenges most health care providers face when it comes to working long hours as well as be comfortable with after-hour/night care which occurs commonly in the health care setting, while at the same time ensuring patient and intern safety.
When I was in training, many of us would fall asleep at the stop light driving home after our shift of, for example, 5 am Tuesday ended 6:30 pm Wednesday night.
According to Section VI-Memo 3, the ACGME additionally states they want to optimize the “quality of care transitions and hand-off” of patients when interns check out after their shift.
In 1984, Libby Zion was being treated in The New York Hospital for agitation and depression and “jerking movements”. Her daily medication was Nardil, an MAO inhibitor, and when she became agitated one evening, the intern gave her Demerol, a pain killer. No one knew of a potential interaction at the time (no Epocrates) and unfortunately she went into a serotonin syndrome, with a temperature hiking to 107, ultimately succumbing to cardiac arrest. The family indicted the entire medical staff but the jury declined awarding murder convictions, but did charge the PGY-1 and PGY-2 resident with 38 counts of gross negligence. This tragic case raised global awareness on the risk of drug interactions, serotonin syndrome and the danger of overworking our medical interns and residents.
To read more, the ACGME memo is linked here: Section VI – Memo 3