Medical school Council urges limits on residents' hours - HR News - Accreditation Council for Graduate Medical Education

HR Magazine, April, 2003 by Ann Pomeroy

Medical residents should be limited to working 80 hours per week, according to final standards on resident duty hours announced by the Accreditation Council for Graduate Medical Education (ACGME).

In the wake of disquieting reports of medical errors with sometimes fatal outcomes and increasing concern that sleep deprivation among young doctors could be dangerous for them and for their patients, groups such as the Washington, D.C.-based advocacy group Public Citizen, the American Medical Student Association (AMSA) and the Committee of Interns and Residents (CIR) have been lobbying medical organizations and government officials for stricter limits on medical residents' work hours. (See "The Doctor Is Still In," HR Magazine, February 2002.)

ACGME is a private organization that accredits about 7,800 medical residency education programs in 26 specialties. Residency programs that fail to comply with the new standards could endanger their accreditation. The new standards were issued Feb. 17 and will take effect July 1.

The 80-hour duty period will include in-house calls and will be averaged over four weeks. "Under limited circumstances, residency programs may be allowed to increase duty hours by 10 percent if doing so is necessary for optimal resident education and patient care," ACGME said. Duty hours include time spent on such activities as patient care, administrative duties related to patient care and academic activities.

The standards also include the following provisions:

* Residents must be given one day out of seven free from all clinical and educational responsibilities, averaged over four weeks.

* Residents cannot be scheduled for in-house call more than once every three nights, averaged over four weeks.

* Duty periods cannot last for more than 24 consecutive hours, but residents can remain on duty for up to six additional hours to hand off patients to new teams of caregivers, maintain continuity of care or participate in educational activities.

* Residents must be given adequate time for rest and personal activities. They should have a minimum of 10 hours between daily duty periods and after in-house call.

Residency programs that fail to comply with the standards can be placed on probation or have their accreditation withdrawn.

Standards Called 'Inadequate'

Some groups remain skeptical that the new standards will work. Peter Lurie, M.D., deputy director of Public Citizen's Health Research Group, termed the new regulations "made quate. They are not what they appear to be." For example, said Lurie, "80 hours is not really 80 hours, because it's averaged over a four-week period. That means you can still work a 110-hour week"

Furthermore, said Lurie, "24 hours is not really 24 hours either, it's 24 plus six."

Amanda Guma, political coordinator for CIR, agrees with Lurie that there are "loopholes" in the 80-hour duty provision. Guma also noted that the ACGME eased the final standards. The draft standards released last June called for a mandatory 10 hours off between shifts. The final version makes this provision a "recommendation."

Guma also is concerned about enforcement of the regulations. The new rules call for an annual Internet survey of residents, she noted, "but I doubt the effectiveness [of such a survey]. Residents are beholden to their supervisors, and whistleblower protection is inadequate."

CIR believes that federal enforcement of work hour restrictions is necessary, Guma said, and the organization will continue to work for such oversight. Bills restricting residents' hours introduced in the House (H.R. 3236) and the Senate (S. 2614) last year failed to make it out of committee.

Public Citizen also intends to continue its push for congressional action. "We had more than 70 co-sponsors last year [for the House bill], and we will go at it again," said Lurie.

Last October, the U.S. Occupational Safety and Health Administration (OSHA) denied a petition from Public Citizen, CIR, the American Medical Student Association (AMSA) and other groups urging federal regulation of resident work hours. In a letter to Public Citizen, OSHA Assistant Secretary of Labor Jim Henshaw wrote, "The ACGME and other entities are well-suited to address work-duty restrictions on medical residents and fellows. These entities have extensive experience in patient health, employee health and medical education and training."

ANN POMEROY IS MANAGING EDITOR FOR PROFESSIONAL EMPHASIS GROUP NEWSLETTERS.