Accreditation Council to Limit Working Hours for Medical Residents to Reduce Errors
The Accreditation Council for Graduate Medical Education, which accredits the nation's teaching hospitals, yesterday announced the first national limits on the number of hours that medical residents may work in an effort to reduce the risk of "dangerous errors by sleep-deprived young doctors," the New York Times reports. The new rules, scheduled to take effect in July 2003, will limit the workweek for residents to 80 hours. In addition, the rules will require that residents have at least 10 hours of rest between shifts and do not work more than 24 hours at a time. The rules also will require hospital faculty directors and program managers to "assess the residents for signs of sleep loss and fatigue" (Altman/Grady, New York Times, 6/13). Many residents work 36 hours at a time and more than 100 hours a week, the Philadelphia Inquirer reports (Goldstein, Philadelphia Inquirer, 6/13). Last month, a group of medical residents filed a lawsuit against a number of teaching hospitals, seven medical associations and the National Resident Matching Program, alleging that they "illegally contracted, combined and conspired among themselves" to pay residents low salaries and require them to work long hours American Health Line, 5/8).
David Leach, executive director of the accreditation council, said, "As the principal body to ensure quality educational programs in the context of quality patient care, the (council) has responded with clear standards, strict compliance mechanisms and strong sanctions for violators" (Philadelphia Inquirer, 6/13). The council represents medical groups, including the American Hospital Association, the Association of American Medical Colleges, the American Medical Association and the American Board of Medical Specialties, and accredits about 7,800 hospital residency programs nationwide. Leach said that the council will "enforce the new rules aggressively" through confidential Internet surveys and hospital visits with residents to discuss potential violations (New York Times, 6/13). Hospitals that do not adhere to the rules could lose accreditation, a status "required for federal funding" (Pacio, Los Angeles Times, 6/13).
The Association of American Medical Colleges, which in the past has opposed restrictions of work hours for residents, yesterday endorsed the new rules, the Washington Post reports. However, Jordan Cohen, president of the association, said that the rules may force hospitals to hire additional employees, which could cost millions of dollars (Connelly, Washington Post, 6/13). In the past few years, budget issues have forced hospitals to reduce their nursing and support staffs, which has contributed to longer hours for residents (Scarponi, AP/Newsday, 6/13). Cohen said that the association would "explore the effects this new policy may have on teaching hospitals' faculty and work with our institutions to manage any economic impact" (Washington Post, 6/13). Some groups criticized the new rules as "too weak." Eric Scherzer, associate director of the Committee of Interns and Residents, questioned a provision in the rules that will allow hospitals to extend shift times for residents by six hours for "patient transfers and educational activities." He said, "For (the council) to come out with a standard that basically says 30-hour shifts (are acceptable) is a step in the wrong direction" (Philadelphia Inquirer, 6/13). The AMA next week plans to issue separate recommendations on the number of hours that residents should work (AP/Newsday, 6/13). In addition, Sen. Jon Corzine (D-N.J.) and Rep. John Conyers (D-Mich.) have introduced legislation to address the issue (New York Times, 6/13). To listen to an NPR "Morning Edition" report on the new rules and an interview with Dr. Steve Davis, a second-year internal medicine resident at the University of Chicago Hospital, click here after noon ET. Note: You must have RealPlayer Audio to listen to the report (Edwards, "Morning Edition," NPR, 6/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.