Are We Killing Our Profession in The Era of ACGME Regulations?

Ameer Hassoun

A decade ago when I started my medical training, we celebrated, as residents, the impact of duty-hours regulations on our daily lives. We were the first generation to experience the winds of change. This change was prompted by the famous case of Libby Zion in my home state of New York. The death of this young girl lead to an unprecedented ripple that changed the world of medical training in the United States.

Since then the Accreditation Council for Graduate Medical Education (ACGME) implemented rules and regulations to limit residents’ fatigue and work hours. This was an important step to help create checks and balances to limit the overdependence on trainees.

While I am a big advocate of such regulations, I have seen residents and fellows gradually drift from the core of what our profession is all about – patient care.  In the past few years, after I started my job as an attending physician, I noticed some residents limiting their productivity so that they won’t be “overworked.” Some residents and fellows became apathetic regarding care for patients in the last hour of their shift, because they wanted to leave on time. I even had a trainee who left me with a patient who was having an acute stroke, because it was time to go home! On the other hand, program directors and administrators are fostering such approach due to fears of ACGME and RRC citations. Are we creating a generation of physicians who are apathetic, less invested, and more self-centered? Let’s not forget that with such regulations they are less exposed to pathologies that they will have to take care of in a few years’ time.

Recently, the Journal of Graduate Medical Education (the official journal of ACGME) published a meta analysis that concluded that “duty hours alone has not resulted in improvements in patient care or resident well-being. The added duty hour restrictions implemented in 2011 appear to have had an unintended negative impact on resident education.”

We as attending physicians took the burden without any regulations or limitations. We as supervisors will be blamed if we instructed our trainee to stay a bit longer to learn from the case they are working on. I think such rules restrict attending physicians and prevent them from teaching appropriate compassion and care. I am not claiming that all attending physicians are the same. There are some who just want to keep trainees for service reasons, and we need some form of protection against that. The analysis also recommended seeking new approaches to the issue of physician fatigue and its relationship to patient care and resident education.

The balance between training, education, experience and work hours needs to be revisited, so that we don’t lose what our profession is all about – patient care!

How do you feel about this topic? Please share your comments and experiences.

Ameer Hassoun

Ameer Hassoun

Assistant Clinical Professor in Pediatrics and Emergency Medicine at New York Presbyterian - Queens
Ameer's professional interests include medical education, international health, and quality improvement. He is the founder and manager of the Visual Diagnosis in Pediatric Emergency Medicine Facebook group.
Ameer Hassoun

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Ameer Hassoun

Ameer Hassoun

Ameer's professional interests include medical education, international health, and quality improvement. He is the founder and manager of the Visual Diagnosis in Pediatric Emergency Medicine Facebook group.

2 Comments

  1. the real issue is “do more with less”. As you mentioned, attendings have mainly filled the gap and shouldered larger burden. The next great leap is to create healthy work environment for everyone, not just students Can’t just fix one part of the car, or it will still drive crooked…

    • Well said David! We have to get a comprehansive plan to tackle these issues. This plan should reform these regulations to include attending physicians in order to preserve the inner core of our profession.

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