Medical resident work hours

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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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[edit] 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.[2] This process, they contend, reduces the competitive pressures on hospitals, resulting in low salaries and long, unsafe work hours.

[edit] 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."[3]

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.[4] 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 interns and residents in AOA-approved programs may not work in excess of 24 consecutive hours exclusive of morning and noon educational programs. It does allow up to six hours for inpatient and outpatient continuity and transfer of care. However, interns and residents may not assume responsibility for a new patient after 24 hours.

Criticisms of limiting the work week include disruptions in continuity of care and limiting training gained through involvement in patient care.[5]

[edit] References

  1. ↑ Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA (2004). "Effect of reducing interns' work hours on serious medical errors in intensive care units". N Engl J Med 351 (18): 1838-48. PMID 15509817. 
  1. ↑ Drazen JM (2004). "Awake and informed". N Engl J Med 351 (18): 1884. PMID 15509822. 

    [edit] External links

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