Proposed Limits on Resident Work Hours Inadequate
View updated table (August 1, 2002)
|
Public Citizen AMSA/CIR |
AAMC |
ACGME |
|
| Maximum Hours/week | 80 hours | 80 hours | 125 hours |
| Maximum Shift Length | 24 hours | 24 hours | 36 hour call shifts
16 hour regular shifts |
| Minimum Time Off Between Shifts | 10 hours after every shift | 8 hours after every shift | 12 hours only after on call shift |
| Mandatory Time Off | Bill: One 24-hour period every 7 days and 1 full weekend off per month.
Petition: One 24-hour period every 7 days. |
One 24-hour period every 7 days | One 24-hour period every 7 days averaged over 4 weeks. |
| Maximum On-Call Frequency | Every third night | Every third night averaged over 4 weeks | Every third night averaged over 4 weeks |
| Verification Mechanism | Bill: Annual anonymous survey of residents
Bill & Petition: Frequent unannounced inspections |
Defers to the ACGME | Site visits (ranging from every 6 months to once every 5 years)
Annual resident survey |
| Whistleblower Protections | Yes | None | None |
| Hospital/Program Violation Disclosure | Bill: Annual report to Congress on hospital compliance
Petition: Inspection results and work schedules are accessible to public through the Freedom of Information Act |
None | None |
| Enforcement Mechanism | Civil monetary penalties | Defers to ACGME | More frequent review of programs |
References
[1] The Association of American Medical Colleges (AAMC), a group representing US medical schools, released their resident work hour policy guidance in October, 2001.
[2] A 125-hour work week is possible under the ACGME’s proposed guidelines because averaging the on-call frequency over a 4-week period allows for weeks in which residents are on-call every other night. Also, averaging days off over 4 weeks allows for weeks which lack a day off. Therefore, once a month, residents may work a 125-hour week consisting of 3 ½ 36-hour call shifts. When averaged over a month, the ACGME’s standards allow for an average of 104-hour work weeks.
[3] “Continuous hours during on-call assignments should be limited to 32 hours. Continuous time on duty may be extended to 36 hours at the resident’s request, when the resident has had a minimum of four hours of sleep during the on-call period between 10 pm and 6 am.”