Should doctors work 24 hour shifts?

The question of whether doctors should work 24 hour shifts has several aspects: are they harmful to patients, are they harmful to trainees, and are there benefits to trainees if they are going to be required to care for patients for 24 hours after completion of training? In the United States, the question of 24 hour shifts resurfaced with the recent decision of the Accreditation Council for Graduate Medical Education (ACGME) to revise the requirements for all residency and clinical fellowship programmes they accredit. Although many changes were to improve the clinical learning environment related to patient safety and physician wellbeing, the modest change of allowing first year residents to increase their maximum limit of hours on duty from 16 hours to 24 hours received the most attention. Since 2003, the council’s standards for residents’ hours of duty have been based on an 80 hour weekly limit. They have allowed 24 hour shifts (with additional time to transfer patient responsibility) except for interns, who had a 16 hour limit applied in 2011. The council’s comprehensive literature review on residents’ work hours and learning environment found that evidence on the effect on patient safety was inconclusive and that resident learning and the shortened work periods under the 2011 standards resulted in workload compression and increased resident stress and potential risk of burnout. In response to these uncertainties, the American College of Surgeons, the ACGME, and the American Board of Surgery funded the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, a prospective “non-inferiority” study comparing the ACGME 16 hour limits for interns with flexible duty hour policies (up to 24 hour limits per shift). The less restrictive duty hour policies (24 hour shifts) were not associated with an increased rate of 30 day mortality or serious complications (9.1% v 9.0%) based on data from 138 691 patients obtained from the American College of Surgeons national surgical quality improvement programme. This is the best evidence we have that 24 hour shifts do not adversely affect outcomes among surgical patients. Effect on trainees