Medical Resident Work Hours - Toward An 80 Hour Work Week

Toward 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 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."

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. On July 1, 2003, the ACGME instituted standards for all accredited residency programs the requirements below:

The ACGME duty hour standards went into effect in July 2003 and require:

1. An 80-hour weekly limit, averaged over 4 weeks, inclusive of all in-house call activities;
2. A 10-hour rest period between duty periods and after in-house call;
3. A 24-hour limit on continuous duty, with up to 6 additional hours for continuity of care and education;
4. No new patients to be accepted after 24 hours of continuous duty;
5. One day in 7 free from patient care and educational obligations, averaged over 4 weeks, inclusive of call; and
6. In-house call no more than once every 3 nights, averaged over 4 weeks.

Following the ACGME's proposed regulation of duty hours the American Osteopathic Association (AOA) followed suit. Below are the requirements adopted by the American Osteopathic association.

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, averaged over a 4-week period.
4. Upon conclusion of a 24-hour duty shift, trainees shall have a minimum of 10 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.

Another related issue regarding the imposition of maximum hour policies for medical residents is the question of enforcement, where some enforcement proposals have included extending U.S. federal whistle-blower protection to medical residents in order to insure compliance and afford medical residents certain employment protection.