The Doctor is still in: Many resident physicians routinely work more than 100 hours a week. Are long hours a necessary rite of passage or an obsolete practice that endangers patients? - Employee Relations

HR Magazine, Feb, 2002 by Ann Pomeroy

Hartmann says many residents choose to come to New York because of the Bell Regulations. They may have some anxiety about seeing fewer patients, and they may feel oversupervised at times by attending physicians, she says, but on balance the New York rules are an attraction.

Ken Kruger, former president of the American Society for Healthcare Human Resources Administration (ASHHRA) in Chicago and former vice president of human resources and labor relations at New York's Mount Sinai Hospital, says, "Organizations need to self-regulate." Kruger, currently president and CEO of the Healthcare Human Resources Consulting Consortium in New York, believes that "Many top hospitals, including Mount Sinai, do a good job of this. The main issue is, how much do we want to set general standards? One size doesn't fit all."

The New York law prohibits residents from moonlighting if such work will exceed the 80-hour maximum per week or the 24-hour consecutive work limit.

Although he says the law probably helps prevent some abuses, "many residents want to moonlight because they want to make contacts for their future medical practice or because they have large medical school loans to pay back."

Hartmann believes that "nobody wants to moonlight. They do it to help pay off their loans."

Federal Regulatory Efforts

At the federal level, various groups are lobbying for regulation of resident work hours similar to restrictions for airline pilots and truck drivers. Last April, the advocacy group Public Citizen, AMSA and the New York-based Committee of Interns and Residents--a union representing 10,000 residents--jointly filed a petition with the Occupational Safety and Health Administration (OSHA) asking it to adopt federal regulations limiting residents' hours.

The petition calls for OSHA to limit residents' hours to 80 per week, with at least one 24-hour off-duty period per week, and to limit shifts to a maximum of 24 consecutive hours. It also calls for on-call shifts to be no more frequent than every third night with at least 10 hours off between shifts. Those are essentially the limits imposed in New York.

Although the ACGME sets accreditation standards for hospitals, the petition said that these standards are voluntary guidelines and alleges that "a significant proportion of hospitals across the U.S. have failed to meet them." The ACGME can shut down a program that violates its standards, but "it's hard to get accurate data with just one site visit lasting only one day," says Hartmann.

In a statement responding to the OSHA petition, the ACGME noted that its standards broadly address education, resident safety and safe patient care, and acknowledged that "it is rare that a program's accreditation is withdrawn because of failure to comply with any single standard." However, the council says it has helped bring programs up to standard by monitoring compliance and citing programs. It points out that hospitals that lose their accreditation will lose some of their Medicare reimbursements and will drive away talented residents.