Are Resident Work-Hour Protections Being Rolled Back?

Proposed changes to the standards that govern accredited residencies are raising concerns about potential roll-backs of work-hour protections.

In its proposed revision of the Common Program Requirements, the Accreditation Council for Graduate Medical Education (ACGME) suggested eliminating the requirement that residents have 8 hours off between shifts, and reducing the mandatory rest period after a 24-hour in-house call from 14 to 12 hours.

It also proposed removing the rule that prohibits residents from being scheduled more than every third night over a 4-week period, along with eliminating the separate night-float requirement and ability of specialty Review Committees to set limits on the frequency of night-float assignments.

Bryan Carmody, MD, MPH, of Eastern Virginia Medical School in Norfolk, who runs a popular blog on medical education, told MedPage Today that these proposed changes are “potentially very significant.”

“Ever since duty hours became a thing, there’s been a slow but unidirectional trend toward what might be considered more humane working hours,” Carmody said. “This would be the first rollback of any of that.”

An ACGME spokesperson told MedPage Today that the proposed changes eliminate “much of the additional detail that has accumulated over time.”

“The intent is not to reduce protections for residents, but to focus accreditation requirements on the standards that matter most while giving programs appropriate flexibility in how they meet them,” the spokesperson said.

They also emphasized that the proposal “does not eliminate the 80-hour weekly limit on clinical and educational work.”

“Programs will still need to design schedules that comply with that limit, and it would be difficult to do so without building appropriate opportunities for rest into those schedules,” they said. “In fact, the proposal would require the 80-hour average to be calculated within a single clinical assignment or rotation, rather than allowing hours from different rotations to be averaged together.”

But many are still wary about what the proposed changes would mean in practice.

Phillip A. Dixon, MD, MBA, MPH, president-elect of the American Academy of Emergency Medicine, told MedPage Today that his organization “supports reducing unnecessary administrative requirements in graduate medical education” but that “flexibility should not come at the expense of resident well-being, patient safety, or high-quality training.”

Dixon noted that emergency medicine has unique scheduling demands that make specialty-specific work-hour protections important. He shared the examples of the existing 12-hour limit on emergency department shifts, and the policy that residents should have no more than 60 scheduled emergency department patient-care hours and 72 total hours per week. These safeguards should be preserved, he said.

Indeed, the Council of Residency Directors in Emergency Medicine (CORD-EM) is seeking input from members through Oct. 1 to shape their response to ACGME.

In an Instagram video, family medicine and sports medicine physician Chris Hong, DO, noted that “8 hours off already isn’t enough time to commute, eat, shower, decompress, and sleep.”

“I believe these changes could leave residents even more exhausted, worsen mental health, and increase the risk of medical errors,” Hong said.

Yash Shah, MD, a gastroenterology fellow at the University of Arkansas for Medical Sciences, wrote in a post on X that “patient safety isn’t separate from trainee well-being. It’s the same fight.”

He added that having written rules governing residency work-hours are important: “Delete it and there’s nothing to violate, nothing to report, nothing to enforce,” he wrote. “The rule is the only leverage.”

Public comments on the proposed changes are open until Oct. 22. The ACGME spokesperson said it will consider the feedback received from public comments before any changes are finalized.