Despite concerns from the public about safety, the private group that oversees physician training voted to allow young doctors to work shifts as long as 28 hours.
The new rules, which begin on July 1, relax work restrictions put in place in 2011, when mounting evidence showed that exhausted residents — the term for doctors in training — were endangering both patients and themselves. Currently, first-year residents are restricted to 16-hour shifts.
Leaders of the Accreditation Council for Graduate Medical Education said the work limits for first-year residents, known as interns, needed to be extended to match the 28-hour shifts now allowed for more experienced trainees. They said it was harming interns' education by reducing their time in the hospital.
Surgeons had been especially critical of the 16-hour limits, saying that at times interns were forced to leave the surgical team during an operation to avoid breaking the rules.
The change was called "reckless" by Public Citizen, the national consumer group that had been working with concerned physicians to try to defeat the proposal.
"As a medical resident, I've seen firsthand how exhausted and accident-prone my colleagues are during extremely long shifts," said Eve Kellner, president of the Committee of Interns and Residents at the Service Employees International Union. "As a patient, I fear putting my life into the hands of a first-year resident physician who has been awake for 28 hours or longer."
All doctors in training will still be limited to working 80-hour work weeks, averaged over four weeks.
Studies have found that sleep deprivation is comparable to alcohol in its ability to impair performance. In one study, interns working in the intensive care unit for 24 hours or longer made 36% more serious medical errors than those working shorter shifts.
The extended shifts also expose residents to a higher risk of car accidents as they drive home from work.
Decades ago, there were few limits on how long doctors in training could work. But the death of 18-year-old Libby Zion in a New York City hospital in 1984 raised questions about the system. Zion's father learned that his daughter's primary doctors had been two residents who were caring for dozens of patients with little supervision.
Because of the risks, the council adopted limits on resident hours in 2003, and further restricted the hours for interns in 2011.
But the caps have been costly to hospitals, which have hired more staff to do work once performed by the physician trainees.
Medicare pays the teaching hospitals as much as $130,000 or more a year for each resident, although the trainees get little more than half of that as salary.
The council's 35-member board, which voted on the proposal at the end of last month, includes four hospital executives. The group said Friday that it would not release details of the vote.
The council had earlier accepted comments from the public on the proposal, but refused to release those comments.
Public Citizen commissioned a survey of 500 Americans and found that 86% said they wanted to keep the 16-hour limit for first-year residents in place. And 80% of those people wanted similar 16-hour limits for the more experienced residents.