AMA May Endorse New Guidelines Limiting Medical Residents’ Hours

The American Medical Association is considering endorsing new guidelines limiting the number of hours medical residents can work when it holds its annual meeting this week in Chicago, the AP/Washington Post reports (AP/Washington Post, 6/16). The Accreditation Council for Graduate Medical Education, which accredits the nation's teaching hospitals, on Wednesday announced that, beginning in July 2003, it will limit the work week for residents to 80 hours and will require that residents have at least 10 hours of rest between shifts and do not work more than 24 hours at a time (California Healthline, 6/13). One proposal the AMA could debate this week is similar to the ACGME guidelines, requiring residents' hours to be limited to 84 hours per week and limiting consecutive hours to no more than 24. Many residents currently exceed 100 hours per week, leading to many surgery or medication errors, the AP/Post reports. ACGME Executive Director David Leach said his group would welcome the AMA's endorsement, and added that as an advocacy group, the AMA could help educate hospitals, which stand to lose their accreditation if they do not comply with the guidelines, about the new regulations (AP/Washington Post, 6/16).

Meanwhile, many medical residents are concerned that loopholes in the council's new guidelines could result in little actual change in their work schedules, the San Francisco Chronicle reports. The guidelines do not set a flat 80-hour work week but allow time to be averaged over a month, meaning some residents could continue working 90 or more hours some weeks. The rules also state that a resident must have one day off every seven days, but days off also could be averaged over a month. Some medical specialties also could be exempt from the rules, and some residents could work up to 30 hours at a time. ACGME says it will enforce the new guidelines with increased inspections, and it will employ surveys of residents to "pinpoint problem institutions" (Hall, San Francisco Chronicle, 6/16). WAMU's "Diane Rehm Show," a syndicated NPR program, today hosted a discussion on the ACGME guidelines. Guests included Dr. Ruth Potee, president of the Committee of Interns and Residents; Association of American Medical Colleges President Dr. Jordan Cohen; and Dr. Marvin Dunn, director of residency review committee activities for ACGME. Check local NPR listings for show times. The full segment will be available online in RealPlayer Audio after the broadcast ("Diane Rehm Show," WAMU, 6/17).

Several newspapers have weighed in on the issue of reducing residents work hours. Following is a summary of the editorials:

• A New York Daily News editorial says, "The accreditation council's rules reflect the 80-hour limit -- which is still too demanding, considering the nature of the job. But a least it's a beginning, an acknowledgment of the need for change" (New York Daily News, 6/14).
  
• A New York Times editorial says, "Patients can only welcome the prospect of stricter limits on the number of hours that medical residents will be allowed to work in the nation's teaching hospitals." Although ACGME plans to "enforce the new rules aggressively," the editorial concludes, "Codifying the rules into law would be a sensible step to increase the pressure for vigorous enforcement" (New York Times, 6/14).
  
• A Philadelphia Inquirer editorial says the council deserves credit for making the "incremental move" to limit residents' hours to 80 hours per week, but asks how "draconian are today's schedules for this to qualify as reform?" The editorial concludes, "This medical 'revolution' is only one small turn of the wheel needed to make sure doctors aren't too tired to doctor" (Philadelphia Inquirer, 6/16).
  
• A St. Petersburg Times editorial says that the more than 100,000 medical residents working at hospitals across the country cannot make "decisions on complex combinations of drugs, monito[r] surgical patients for complications and reac[t] to whatever emergencies may arise" on only a few hours of sleep. The editorial concludes, "For decades residents have been exploited by the profession they will be joining. The rule changes envisioned by the council are long overdue" (St. Petersburg Times, 6/14).