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Residencies successful in curbing work-hour violations

Fewer residency programs were cited for excessive work hours by the Accreditation Council for Graduate Medical Education in 2000.

By Jay Greene, amednews staff. July 30, 2001.

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Residents in some training programs seem to be working fewer hours as academic medical centers institute more on-call night float systems and hire more staff, including hospitalists and allied health professionals.

Other residents are working less simply because hospitals have been forced to close certain units because of nursing shortages.

But critics of excessive resident work hours say more needs to be done to improve the work and educational environment of physicians in training. Hundreds of programs still have heavy-duty schedules that require residents to work up to 130 hours a week, with some shifts lasting more than 36 hours, residency experts say.

"We struggle with how to create the best learning environment for continuity of care," said David Battinelli, MD, president of the Assn. of Program Directors in Internal Medicine and program director at Boston University Medical Center.

"Is it possible to understand the natural history of a disease by hour eight vs. hour 18?" Dr. Battinelli asked. "The old school said you need to be there the entire time to study the whole disease. The new school says you can't do that practically. You also have to be concerned with physician well-being."

Spurred by resident and medical student activism and a greater public scrutiny of medical errors in hospitals, many of the nation's 7,750 residency programs are looking for ways to reduce work hours while expanding residents' outpatient experiences and new technology training.

"It is going to be hard to get the work hours down," said Timothy Flynn, MD, president of the Assn. of Program Directors in Surgery and program director in vascular surgery at Shands Hospital at the University of Florida in Gainesville. [...]