Gopi Astik, MD • October 20th, 2011
Anyone involved in academic medicine probably is aware of the new ACGME duty-hour restrictions that went into effect on 7/1/2011. For those of you who aren’t, the new guidelines state that PGY1 residents cannot work for longer than 16 hours straight. If they do work longer, they require strategic uninterrupted naps. The restrictions on PGY2 and PGY3 residents are less stringent, but the total consecutive hours that a PGY2 (and beyond) can work was lowered from 30 to 28. One other change is that residents are mandated to have 8 hours off, and recommended to have 10 hours off, between shifts. As one of the chief residents when this change occurred, I really want to share my thoughts about it.
For our program, these new rules have meant a transition to shift work on all days of the week. We have had night float for the past 5 or 6 years, but we had overnight “long” calls during the weekends. I can see both good and bad things about this new call change. We avoid some resident fatigue, because interns work only 16 hours maximum. The problem is that, in order to accommodate for the shifts, giving interns an entire weekend off is very difficult. The Golden Weekend is becoming somewhat of a myth to our intern class. Transitioning to a shift-based call system also points out major flaws in our handoff process. We have noticed that our “checkouts”/handoffs were not relaying the needed information and, as a program, we’ve been trying various things to improve this process.
One thing I ask of every resident reading this page is — be nice to your chief resident! We didn’t make this rule, nor did we have any input into the decision, but we have to enforce it. The more restrictions that the ACGME puts on resident work hours, the more complaints I hear from attending physicians about having to pick up the slack. We often do not have the manpower to ensure that every service will have a “full team” of interns and residents to complete daily work, and we have to rely on staff physicians to fill the service gap.
Our job to ensure that residents do not work more hours than they are allowed and, thus, avoid citations against our program. Problems arise mostly when residents who are on weekday call (which ends at 7PM for us) delay leaving because of notes, orders, or patient care issues. If a resident does not leave until 9 or 10PM, they cannot come back into the hospital until 7 or 8AM. This means that those residents probably have not seen all of their patients before rounds begin, and the responsibility falls on other residents or the attending physician. I realize that this issue is a culture shock for some of the older physicians who “used to walk to work in a foot of snow uphill both ways,” but these are the rules, and we all have to live by them. So, please, cut your chief a break!