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Reactions to ACGME: Same 80-work week, new duty hour periods and supervision rules

Hospitalist Leadership Connection, June 29, 2010

After releasing its long awaited 2010 revised standards, the ACGME this week released information on the new Common Program Requirements. The ACGME draft proposal  includes maintaining the 80-hour work week, but it does update duty hour periods and supervision rules for first-year residents, effective July 2011.

The ACGME curtails hours for post graduate year 1 (PGY1) residents, limiting their duty periods to 16 hours each, and they are not permitted to moonlight. PGY2 residents may be scheduled for a maximum of 24 hours of continuous duty and stay in the hospital to finish other tasks, such as handoffs; moonlighting counts toward the 80-hour work week. The new requirements also state that napping is strongly suggested between 10pm-8am.

Regarding supervision, PGY1 resident must be supervised directly or indirectly.

Hear what bloggers are saying about the new ACGME rules:

Wachter’s World (Robert Wachter, MD, SFHM)
“I’m pleased that the ACGME resisted the pressure to cut the weekly duty hours further. In addition to the massive costs of replacing resident labor (with hospitalists or allied health professionals), I believe that lower hours would be detrimental to training: residents would be forced to pack more work into less time, shorter hours would further promote a run-for-the-doors mentality, we’d be stuck with even more risky handoffs.”

FutureDocs (Vineet Arora MD, MPP)
“One thing is clearly different - interns (first year residents) will only work 16 hours maximum while residents (after internship) can work longer – up to 28 hours (I should say 24+4). . . While handoffs will undoubtedly be more frequent for interns working 16 hour shifts, programs are also asked to take steps to ”minimize transitions of care.”  They also require all residents to be competent in handoff communication and for programs to monitor handoffs so they are structured, effective and safe.”

White Coat Underground (PalMD)
“Even the latest ACGME rules (which take effect July 2011) fail to address the most significant implications of the problem. . .If we're going to cut back on hours, we need to re-evaluate whether the new hours are sufficient to meet educational needs. If not, we are going to have to find a way to fund longer training programs and to fund the debt-ridden trainees who will spend extra years not paying their educational debt. Quick fixes, even smart ones, aren't going to do the trick.”

You can find comparison charts from the ACGME executive summary and on The New England Journal of Medicine.

The standards are open for formal review and comment until August.

[via ResidencyManager.com]

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