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Proposed Duty Hour Limits for Residents Met with Scrutiny

Joe Cantlupe, for HealthLeaders Media, March 17, 2011

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.

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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