Proposed Duty Hour Limits for Residents Met with Scrutiny

Joe Cantlupe, for HealthLeaders Media , March 17, 2011

Resident Physician: Take a nap. Limit your hours.

Sounds good, no? The decades long-debate over how long resident physicians should keep working per shift, and how much rest they need, continues, like a long-running dream. These are major questions being considered by medical directors of residency programs as new regulations come online in July.

The Accreditation Council for Graduate Medical Education (ACGME) is preparing to launch regulations that say first-year physician residents must work no longer than 16 consecutive hours. The plan includes provisions to replace standards that now allow interns to work 24 consecutive hours.

The ACGME, which is promulgating the regulations, is a non-profit organization that oversees training programs for resident physicians and is responsible for regulating and enforcing resident physician work hours, and accreditation of post-MD medical training programs.

While the ACGME insists it has made inroads into the fatigue issue and related patient safety concerns, physician residency program directors suggest in a new survey they aren't exactly pleased with the plan. I don't think it will do much to allay their concerns about physician exhaustion and patient care.

Residency program directors' reactions to the ACGME duty hour recommendations "demonstrate a marked degree of concern" about physician education, according to the study by Darcy A. Reed, MD, MPH, Division of Primary Care Internal Medicine for the Mayo Clinic, and her co-authors, reported in the March issue of Mayo Clinic Proceedings. The Mayo Clinic was not associated with the survey, which was conducted after the ACGME published its recommendations.

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1 comments on "Proposed Duty Hour Limits for Residents Met with Scrutiny"

Ken Murphy, MD, FACS (3/17/2011 at 10:14 PM)
This is ridiculous, as it has been since inception. The education of prospective physicians depends upon understanding how disease develops and responds to treatment over time. This can only be obtained by being available to the patients we care for precisely when they are ill. Increased supervision by attendings and upper level residents, I believe, is highly desirable; why would we not take advantage of those who have gone before? I certainly agree that fatigued residents are more prone to errors and that patient safety is our prime consideration ("first do no harm"), and I vivdly recall every-other-night call as Chief Resident in Surgery, but illness does not assume a holding pattern after business hours and on weekends/holidays. In the real world of medicine it will be critical that physicians have as-complete-as-possible knowledge of the disease processes with which they will deal. I do not recall a single time when I was "too tired" to attend a patient. I will admit that I am a dinosaur (30 yrs solo practice) but I say let's get the more experienced physicians much more involved in education of trainees, including those in private practice. Just as an aside, there is a wealth of education available in private practice, and we have yet to take adequate advantage of it in our training programs. Perhaps that is a direction which training programs should consider? Thanks. Ken Murphy, MD, FACS (Ret.) Medical Director, CRPHO UR Physician Advisor, CRMC Conway, Arkansas




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