On July 1st, 2017, the updated Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements will take effect. The increase in the maximum continuous work hour shift from 16 to 24 hours has surely received the most attention, and will likely continue to do so.
However, the ACGME did make some significant improvements in this latest guideline update worth noting. Among them was a slight conjunctional switch from an “and/or” to an “and” that now requires all residency programs in the country to ensure both post-call rooms and transportation options for residents who may feel too fatigued to safely return home.
Currently, the regulation reads that the “sponsoring institution must provide adequate sleep facilities and/or safe transportation options for residents who may be too fatigued to safely return home.” While some residencies already provide both of these options, many only provide post-call rooms. These residencies tend to be in more rural parts of the country, where public transportation is less available, and taxi services are more expensive than in the cities.
This all changes on July 1st. Every residency program in the nation “must ensure adequate sleep facilities and safe transportation options for residents who may be too fatigued to safely return home.” The logistical details of this will depend on how sponsoring institutions decide they want to “ensure” these benefits are provided, but this is a significant change, one that will potentially help a lot of residents with responsibilities extending beyond their work in the hospital.
And those responsibilities are increasing.
Data from resident surveys have found that about 1 in 4 medical students are entering residency with children. These surveys also find that family-related stressors are strongly contributing to emotional exhaustion and burnout. Residents often have limited time at home with family, and erratic schedules often mean there’s no way to accommodate family demands, especially if that family demand is a toddler at home with a cold.
Under the current system, exhausted resident parents have very limited options in this situation. They can hope their spouse or parent can watch their kid (assuming they are not a single parent), they can pay a babysitter extra to stay while they fall asleep in the post-call room, they can hire a taxi themselves (which adds a huge financial burden to an already debt-burdened resident), or they could risk it behind the wheel and drive home.
That last choice is what this change is meant to avoid. With numerous studies showing that the risk of a motor vehicle crashes increases substantially in residents who routinely work longer hours, and that post-call residents can be impaired as much as inebriated residents who are not post-call, placing residents in a position where that may be their only option is dangerous. The ACGME seems to finally agree.
These changes are not perfect, as evidenced by the numerous residents who are already at programs that provide these transportation options and still struggle to keep up with life outside the hospital. More needs to be done to ease the stress burden on residents and even attendings in the hospitals. The lack of on-site child care services, for instance, is a huge logistical and financial burden across all levels of practice. Other professional industries have far outpaced medicine in this regard, and the gap is only increasing. Studies have found even in the most child-friendly specialties, such as pediatrics, only one-third of programs offered on-site child care, and only 13 percent offered sick-child care.
And none of these changes will address many of the new issues posed by the increases in work hours. But the transportation change will give residents no longer on a shift a lot more options to spend time with their families. It’s a step in the right direction.
Christopher Gable is a medical student.
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