Work Hour Limits For Residents example essay topic

According to the ACGME Work Group on Resident Duty Hours and the Learning Environment, the only way residency programs and their sponsoring institutions can achieve a true 'education' program, as well as provide high quality clinical care, is by attending to the issue of resident duty hours and by placing a higher value on resident education and safe patient care than on meeting service demands. Under the new common program requirements, residents will be limited to 80 hours of work per week, overnight on-call duty will be limited to no more than every third night, and residents will have one day of every seven free of responsibility for patient care, all averaged over a four-week period. There will be a 24-hour limit for on-call duty with an added period of up to 6 hours for continuity and transfer of care, educational debriefing and didactic activities; no new patients may be accepted after 24 hours. Between periods when they are on duty, residents will have a minimal rest period of 10 hours. If they take calls from home and are called into the hospital, the time they spend in the hospital will count toward the weekly limit. Teaching hospitals have increased responsibility for monitoring work hours and for patient care support services such as starting intravenous lines, phlebotomy, and transport activities to reduce the time that residents spend on these routine activities.

The ACGME is also strengthening its systems for enforcing the requirements, including conducting detailed surveys of residents before site visits occur. In general, the council will reassess compliance within six months after citing a program for violation of duty hours and rapidly review the practices of institutions that do not make necessary changes. The standards have a notable exception. Individual programs may apply to the graduate medical education committee of their sponsoring institution "for an increase in the limit of up to 10 percent, if they can provide a sound educational rationale".

Such an increase, which could raise the limit to 88 hours per week, requires the approval of both the graduate medical education committee and the residency-review committee for the specialty. Initially, the ACGME proposed a second exception that would have permitted the exemption of an entire specialty and that could have raised the limit to 96 hours per week. In September 2002, after reviewing comments, the ACGME changed its mind. Although the new standards are substantially stronger than the current standards, they are weaker than similar proposals from the American Medical Association and the Association of American Medical Colleges, as well as proposals for federal regulations. After work-hour limits went into effect in New York in 1989, the state provided hospitals with millions of dollars to cover the costs. According to the ACGME Work Group report, it would be disingenuous to understate the added costs of these changes, or the challenge that securing the added funds will present for many sponsoring institutions.

The council, however, unlike states or the federal government, does not pay for the required changes. The immediate costs are a serious problem, particularly for hospitals that are already in financial difficulty. As of September 2002, OSHA had not responded to the petition that it establish work-hour limits for residents. Pending legislation in Congress would set a federal work limit of 80 hours per week, with no averaging among weeks, with overnight on-call duty no more frequently than every third night and a maximum of 24 hours per shift, with additional time for "transfer of direct patient care.

Hospitals would have to comply with these limits in order to participate in the Medicare program. Violators would also be subject to fines of up to $100,000 for each training program. The government would conduct annual anonymous surveys of residents and make public the results for individual programs. Violations and compliance of hospitals and programs would be disclosed to the public and in an annual report to Congress. People who reported suspected violations or cooperated with investigations would be provided with "whistle-blower protections". Hospitals would receive additional funding to cover the costs associated with compliance.

New Jersey may soon become the second state to regulate residents' work hours. In June, the state assembly passed a bill that would establish an 80-hour workweek, averaged over a period of four weeks, for the state's approximately 2400 residents and sent it to the state senate.