The American Medical Association has approved limits on resident work hours. The vote comes on the heels of a decision made by a national group that accredits teaching hospitals. The group decided last week to require that residents only work on average eighty hours a week. A Mayo Clinic spokesman says the restrictions are long overdue.
Residents have complained about having to work long hours for decades. So have patients, concerned about being treated by exhausted doctors. However, the Accreditation Council for Graduate Medical Education spokesman, Dr. Marvin Dunn, says residents are partly responding to patient demand.
"None of us as a patient like to see this doctor this minute this one the next and find out the next one doesn't know what the last one knew," Dunn says. "The joke is, 'doctor, I want you to get a good night sleep before surgery but be with me the whole night after the surgery.'"
Medical residents undergo rigorous training. Some residents say it's not unusual to work more than 100 hours a week. The new rules should provide some relief and reduce the risk of errors by inexperienced doctors who are sleep deprived.
The Accreditation Council for Graduate Medical Education, or the ACGME, will be enforcing the rules. The ACGME accredits about 7,800 residency education programs in the United States, including Mayo.
The group will limit the average workweek to 80 hours and restrict a resident's duty to no more than twenty-four hours consecutively. The organization will also ensure adequate supervision and support staff.
Dr. Cassie Kennedy is a second-year internal medicine resident at Mayo. She says the ACGME's decision is exciting. She says it will help patients as well as residents. "Women especially, but also men with families," she says.
Now she says they can make a decision on which residency to choose or subspecialty to choose, "Based on where their talents lie or interests lie, (rather) than based on how much time that's going to take away from their personal life during training," Kennedy says.
She says she usually works fewer than 80 hours a week.
"Most residents certainly don't work 80 hours," says Dr. Roger Nelson, the dean of the Mayo graduate school of medicine, who oversees resident and fellowship training. "The 80-hour or more than 80-hour residents, although I don't think that's at Mayo, are the ones who work in the hospital. That's when they're on overnight call and so forth so they can approach 80 hours."
Residents at Mayo sign a contract saying they will not talk to the press without Mayo authorization. In private some Mayo residents say the reality is they regularly work more than 80 hours a week.
Nelson says surgery and internal medicine residents tend to work longer hours. But he says radiologists, dermatologists, family medicine doctors in training don't spend as much time in the hospital.
The ACGME visits hospitals like Mayo periodically and interviews residents and faculty. Nelson says Mayo usually fairs very well with their standards.
ACGME's Marvin Dunn says overworking residents has been an issue for a long time. But he says health care is changing. He says hospital administrators must change their policies to meet the new realities.
Also he says many cash-strapped hospitals have laid off support staff so some residents find themselves doing things like pushing gurneys from ward to ward.
"So all of these come together to make a difficult situation for residents to have a proper learning environment and quite frankly a proper health care environment," Dunn says.
Some teaching hospitals are concerned about the cost of hiring more staff to accommodate the resident work rules. Many teaching hospitals rely on residents as an inexpensive source of labor.
Yale-New Haven Hospital's surgery program was threatened with a loss of accreditation because of the long hours residents worked. So the hospital is hiring twelve physician associates to reduce the residents' workload.
The Mayo Clinic's Dr. Nelson says it doesn't plan on hiring more staff to accommodate the new rules yet.
The ACGME will begin enforcing the rules in July 2003.