Obviously, she says, there is concern about the regulations and the impact on residents' fatigue.
Although there are new restrictions about work hours, "we don't know that the residents will necessarily sleep in the hours they aren't working," Reed says. "We assume if they are working fewer hours, they will recuperate and rest, and sleep. But that may not be. There are a lot of other factors involved: family life, level of stress, and many other activities they may be engaged in."
In addition, resident medical directors apparently are concerned that residents may simply work more over a shorter period of time, which could have a dramatic impact on patients as well as the physicians themselves, Reed says. "That's a big concern. If they reduce their hours they just might compress the same amount of work into a shorter period of time," Reed says. "Maybe they will be asked to do the same stuff but do it faster."
Another major concern is "handing off a patient to another physician at the end of a shift," she says. "We know during the hand-off, that is a high risk event. It's a vulnerable time."
How to reduce the risk of an overly tired young physician has been a point of debate for years.In the 27 years since the death of a young woman who was under the care of an apparently exhausted physician in a New York hospital, various groups have debated how much physician time should be regulated.
After the tragedy, New York State initiated changes, and in 2003, the ACGME issued "duty hour" regulations, making them mandatory for all residency programs. The ACGME says the regulations resulted in a significant reduction nationwide in duty hours and fatigue among resident physicians.
This past December, the Institute of Medicine released a report recommending strict work-hour rules. The report, ResidentDuty Hours: Enhancing Sleep, Supervision, and Safety" stated that "30 hours of continuous time awake, as is permitted and common in current resident work schedules, can work in fatigue and adjustment to the 2003 rules are needed. The ACGME' then proposed revised standards.