The debate over regulating hospital residents' hours has flared several times since 1989, when New York state introduced a law limiting residents to no more than 24 consecutive hours on the job. Pressure is on for similar laws nationwide, as groups argue that sleep deprivation is a major contributor to medical errors. Skeptics wonder how the cure will work in the real world of academic medicine. -Chris Rauber
The issue of resident overwork and fatigue is decades old. The recent debate was sparked by the release of the 1999 IOM report on medical errors, which was a real wake-up call on the problem of safety in U.S. hospitals. But the medical community already knows that teaching hospitals are not safety conscious. Physicians can work 36-hour shifts with no sleep and still are expected to make life-and-death decisions. This wouldn't be tolerated in other industries. There should be public accountability to ensure that basic safety standards are met. We have two initiatives under way: a petition to OSHA asking it to regulate residents' hours, and legislation to be introduced in Congress this fall limiting work hours and providing more funding for ancillary staff to help relieve residents of their noneducational duties.
American Medical Students Association
The principal challenges for medical educators in dealing with the issue of resident work hours have been to ensure an optimal learning environment and to create a proper balance between education and patient care. We are certain that these fundamental educational issues cannot be addressed by government regulations. We think that meeting these challenges must remain the responsibility of our community. The AAMC recommends that our member institutions establish guidelines on resident work hours for their individual residency programs. These should permit residents to be on duty no more than 80 hours per week and no more than 24 hours consecutively, and have at least eight hours duty-free between periods on call and 24 consecutive hours free of all duty every seven days.
Jordan J. Cohen, M.D.
Association of American Medical Colleges
For 10 years, New York state has regulated its medical residents' work hours through unannounced monitoring visits to each teaching institution, but no work-hour restrictions are placed on teaching physicians or those who practice in the community. Monitoring programs have relied solely on rigid measurement of the number of hours worked, without compromise. A resident involved in a complicated case may find that he or she is sent home during critical portions of the case because 'their time is up.' This impacts continuity of care and results in the loss of learning opportunities. Institutions and programs must be given the flexibility to adapt regulations to meet their local patient-care and educational needs.
William D. Grant, Ed.D.
SUNY Upstate Medical University
Amid growing concerns regarding resident physician work hours and fatigue, the AMA's board of trustees recently announced that it will take steps to resolve pressing issues in this area. Along with the AMA Resident and Fellow Section, the board will collaborate with other national resident organizations, medical educators and other interested groups to find solutions to stressful resident working conditions. The board and the American Academy of Sleep Medicine will sponsor a symposium in October to develop urgently needed guidelines to alleviate the negative impact that resident work hours may have on patient safety, resident education and lifestyle issues, and will help facilitate discussions on legislative and other options to enforce current work-hour standards.
Peter Watson, M.D.
Resident Board Member
American Medical Association