• Health reform
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Series
• Writers
• Other years

• Search tips
• Email alert
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

• AMA Wire
• CPT
• DMPHP
• JAMA
• JAMA Network
• news@JAMA
• Virtual Mentor
• Physician jobs

Resident work-hour bill lives on in Senate

The measure keeps pressure on physicians despite new ACGME resident work-hour rules.

By Myrle Croasdale, amednews staff. May 19, 2003.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE
•  

The medical education community may have thought federal lawmakers would cut it some slack while it adapted to self-imposed limits on resident work hours, but no such luck.

Sen. Jon Corzine (D, N.J.) reintroduced legislation April 30 to limit the hours medical residents may work. The move keeps the hammer of federal regulation over physicians' heads as they count down to July 1 -- the day when the Accreditation Council for Graduate Medical Education officially restricts all residents to an 80-hour workweek.

Policy watchers say the message to physicians is clear: If you aren't successful in policing yourselves, the government will do it for you.

Darius Goore, Corzine's spokesman, said the senator supported the ACGME efforts but that outside oversight was needed. "The reason why legislation is still necessary is that it will ensure compliance," Goore said. "Many hospitals failed to comply before because there was insufficient oversight and enforcement."

The bill and its companion House legislation, sponsored by Rep. John Conyers Jr. (D, Mich.), would limit resident duty hours to 80 hours per week. The ACGME's cap is 80 hours per week, averaged over four weeks.

Peter Watson, MD, resident trustee of the American Medical Association, said the AMA fully supports the ACGME's efforts. The Association is not opposed to federal legislation but believes it is too soon to go that route, he added.

"Clearly, Corzine and Conyers are sending a message that the public is closely watching what does happen," Dr. Watson said. "These bills give added pressure to get this job done."

Corzine's bill would limit call schedules to 24 hours, with three additional hours to wrap up patient transfers, while the ACGME gives residents six hours to handle the transfer of patients and other postcall tasks.

Unlike the proposed legislation, the ACGME's 30-hour on-call maximum has wiggle room. The council's language says residents "should" have 10 hours off between duty shifts. By not saying "must," the group gives Residency Review Committees some discretion in the number of off-duty hours physicians in training have.

Corzine's bill would go beyond the ACGME's plan by providing whistle-blower protection for residents who report suspected violations. It also would offer an unspecified amount of funding to hospitals to increase staffing levels to handle the redistributed work load.

"It is no longer acceptable to endanger patients with compromised care by sleep-impaired physicians," Corzine said. "This legislation will put some common sense back into physician training and patient care."

Fighting for medicine's role

David Leach, MD, executive director of the ACGME, responded that the council -- not Congress -- is the best organization to restrict and monitor resident work hours, because without its accreditation, teaching hospitals can't get government funding.

"When threatened with loss of accreditation, the vast majority of programs fix the problem, in part, because of the heavy financial incentives associated with Medicare reimbursement," Dr. Leach said. "A large academic medical center may receive $100 million per year from GME reimbursements. The financial consequences associated with loss of accreditation are enormous compared to the relatively trivial fines suggested in some regulatory approaches."

The ACGME's compliance plan includes interviews of resident and program directors, anonymous Internet surveys of residents and reviews of duty-hour documentation.

The ACGME annually reviews 2,100 programs out of the 7,800 it oversees and interviews 16,000 residents each year during site visits.

"The health care system is broken, and residents live in the cracks of that broken system," Dr. Leach said. "The new duty-hour requirements will provoke a redesign of the system."

In fall 2002, the Occupational Safety and Health Administration denied a petition filed by three groups asking it to restrict medical resident work hours. OSHA officials argued that other knowledgeable groups were already addressing this issue, though they made it clear teaching hospitals would be held accountable for documenting resident hours and keeping them within the new constraints.

Paul Rockey, MD, director of the AMA Division of Graduate Medical Education, said self-regulation was critical for physicians.

"One of the fundamental tenets of a profession is to self-regulate," Dr. Rockey said. "Anytime the federal government embarks to legislate in the area of medicine, we relinquish a chunk of our professionalism."

Back to top

 ADDITIONAL INFORMATION: