Thomas J. Nasca

In a counter-intuitive about-face, the Accreditation Council for Graduate Medical Education (ACGME) wants to change its rules governing residents  to let them work 24-hour shifts–a third longer than they are now allowed to work–plus up to four more hours to manage transitions in care.

It seems hard to believe that the group would  tolerate even more exhausted young doctors, rather than moving to, say, increase the number of physicians to share the workload and boost the number of advanced practice clinicians such as nurse practitioners who can perform some of the residents’ duties.

But then organized medicine has always operated as a sort of guild, in which keeping the numbers of practitioners  low, and limiting the scope of practice of non-physicians, has kept physicians’ pay very high, especially in the U.S., whose physicians are by far the world’s best paid. That is one of many factors in keeping American healthcare by far the most world’s most expensive even as population health  is among the worst in the Developed World.

About a decade ago  ACGME  acted  to curb  some of the most brutal aspects of medical residencies, such as barring back-to-back shifts that could last as long as 30 hours apiece.

The organization  says it changed its mind after reviewing the latest research–including a study this year by the New England Journal of Medicine, which said that longer hours for surgical residents did not necessarily pose any safety risks.

“Training to become a practicing physician can be compared to training for a marathon,” said ACGME Chief Executive Officer Thomas J. Nasca, M.D.  “You must learn how to pace yourself, take care of yourself, and recognize your limits. With enough experience comes resilience and the ability to perform under expected, sometimes challenging conditions.”

One wonders if after the next spate of highly publicized patient injuries and deaths linked to the exhaustion and anxiety of young doctors, the organization will change its position yet again.

Some other restrictions remain.  Residents are restricted to working no more than  80 hours a week, and  will get one day off every seven days. However, all of those numbers would be averaged over a four-week period.

The consumer-advocate group Public Citizen denounced the proposed changes,  which are  subject to a 45-day public-comment period.   Michael Carome,  M.D., director of the organization’s health-research group, noted to The Washington Post that that studies have shown that exhausted residents are “a danger to themselves, their patients and the public.”