Medical resident work hours

Medical resident work hours is a term that refers to the often lengthy shifts worked by medical interns and residents during their medical residency. The issue has become a political football in the United States, where federal regulations do not limit the number of hours that can be assigned during a graduate medical student's medical residency. It is not uncommon for medical school graduates to work 80 to 100 hours a week, with surgical residents typically logging over 110 hours a week.

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Long hours

Medical residencies traditionally require lengthy hours of their trainees. Classically, 36-hour shifts are separated by 12 hours of rest, during 100+ hour weeks. The American public, and the medical education establishment, is increasingly recognizing that such long hours are counter-productive, since sleep deprivation increases rates of medical errors. This was noted in a landmark study on the effects of sleep deprivation and error rate in an intensive care unit.^[1] The Accreditation Council for Graduate Medical Education (ACGME) has limited the number of work-hours to 80 hours weekly, overnight call frequency to no more than one overnight every third day, 30 hour maximum straight shift, and 10 hours off between shifts. While these limits are voluntary, adherence has been mandated for the purposes of accreditation.

Critics of long residency hours trace the problem to the fact that resident physicians have no alternatives to positions that are offered, meaning residents must accept all conditions of employment, including very long work hours, and that they must also, in many cases, contend with poor supervision.[1] This process, they contend, reduces the competitive pressures on hospitals, resulting in low salaries and long, unsafe work hours.

Towards an 80 hour work week

Regulatory and legislative attempts at limiting medical resident work hours have materialized, but have yet to attain passage. Class action litigation has on behalf of the 200,000 medical residents in the US has been another route taken to resolve the matter.

Dr. Richard Corlin, president of the American Medical Association, has called for re-evaluation of the training process, declaring "We need to take a look again at the issue of why is the resident there."[2]

The U.S. Occupational Safety and Health Administration (OSHA) rejected a petition seeking to restrict medical resident work hours, opting to rely on standards adopted by ACGME, a private trade association that represents and accredits residency programs.[3] On July 1, 2003, the ACGME instituted standards for all accredited residency programs, limiting the work week to 80 hours. These standards have been voluntarily adopted by residency programs.

On November 1, 2002, the 80-hour work limit went into effect in residencies accredited by the American Osteopathic Association (AOA). The decision also mandates that:

1) The trainee shall not be assigned to work physically on duty in excess of 80 hours per week averaged over a 4-week period, inclusive of in-house night call. 2) The trainee shall not work in excess of 24 consecutive hours inclusive of morning and noon educational programs. Allowances for inpatient and outpatient continuity, transfer of care, educational debriefing and formal didactic activities may occur, but may not exceed 6 hours. Residents may not assume responsibility for a new patient after working 24 hours. 3) The trainee shall have on alternate weeks 48-hour periods off, or at least one 24-hour period off each week. 4) Upon conclusion of a 24-hour duty shift, trainees shall have a minimum of 12 hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be provided. 5) All off-duty time must be totally free from assignment to clinical or educational activity. 6) Rotations in which trainee is assigned to Emergency Department duty shall ensure that trainees work no longer than 12 hour shifts. 7) The trainee and training institution must always remember the patient care responsibility is not precluded by the work hour policy. In cases where a trainee is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided as soon as possible to relieve the resident involved. 8) The trainee may not be assigned to call more often than every third night averaged over any consecutive four-week period.

^[2]

Effects on mortality

A study of over 3000 hospital admissions of Medicare beneficiaries published in 2007 comparing mortality rate before and after implementation of the ACGME standards showed no difference in mortality.^[3]

References