ACGME proposes rolling back resident work-hour protections

Few jobs are more taxing than medical residency, which often involves completing shifts as long as 28 hours with few days off.

Nearly 30% of residents who responded to an American Medical Association survey reported being burnt out last year, and studies show that lack of adequate rest significantly increases the risk of medical errors. Further, burnout could worsen healthcare workforce shortages, according to a 2023 study that noted there’s a shortage of an estimated 45,000 to 90,000 physicians across all medical specialties.

For decades, residency programs have had rules in place regulating how many hours a resident gets off between shifts and how many shifts in a row they can work. The aim is to make sure they can occasionally get some rest and thereby reduce risks to patient safety. But proposed changes from the Accreditation Council for Graduate Medical Education (ACGME), the organization that sets standards for residency programs, would roll back some of those protections.

Three of the proposed changes announced in September would:

• Eliminate a requirement that residents have at least eight hours off between shifts
• Reduce the required time off after a 24-hour shift from 14 hours to 12 hours
• Eliminate a rule that residents can only be scheduled for an in-house call shift once every third night

The changes were proposed as part of a review of residency regulations the ACGME undertakes every 10 years. Susan Holub, a spokesperson for ACGME, told Healthcare Brew in a statement that the proposed updates “are intended to provide programs with greater flexibility in how they meet accreditation requirements while continuing to support high-quality education and patient safety.”

The changes aren’t official yet, and ACGME accepted public feedback on them through Oct. 22. The organization expects to finalize the updated rules in June 2027, and proposed that any changes would be effective July 1, 2028.

Are the rules needed? According to ACGME, the regulations they proposed dropping are redundant because other rules in place, including the requirement that residents work no more than 80 hours per week averaged over four weeks, make it hard for residents not to get at least eight hours off between shifts or to be scheduled for more than one 24-hour shift every third night.

In its rationale for reducing time off between in-house on-call shifts from 14 hours to 12 hours, the ACGME stated that the change would “reduce burden related to developing resident schedules, while retaining sufficient time for rest.”

Holub told Healthcare Brew that the public comments ACGME has received “could lead to further refinement of the proposed requirements,” and that “no final decisions will be made until all comments are considered and the new requirements are approved and published. There will be more updates to the community about the process soon.”

Resident responses. Multiple organizations representing residents have raised concern that these changes would worsen both resident well-being and patient care.

Trina Van, president of the Committee of Interns and Residents, a national union representing residents, said in a statement shared with Healthcare Brew that “while the ACGME says these changes are intended to reduce redundancy and give programs greater ‘flexibility,’ it appears that removing the established safeguards only hurts residents and their ability to provide quality patient care.”

“As doctors, we encourage our patients to get adequate sleep to protect their mental and physical health. We deserve that same opportunity when our patients’ lives are in our hands,” Van added.

The American Medical Student Association, a professional group that represents both med students and residents, released a statement on Oct. 15 saying “rigorous evidence demonstrates that sleep-deprived residents are more prone to serious medical errors, sustain more needlestick injuries, motor vehicle crashes, and suffer higher rates of depression.”

Additionally, the revisions “threaten trainees’ education and quality of life,” the Emergency Medicine Residents Association, which represents residents specializing in emergency medicine, said in an Oct. 7 comprehensive evaluation.

“There should be a protected time of rest in between shifts to protect residents’ well-being. A lack of proper rest puts the resident at risk of harm and negatively impacts their education,” the organization said in response to one of the revisions.

The American Hospital Association declined to comment on the proposed changes. Healthcare Brew also reached out to the American Medical Association but did not hear back by publication.