Residency work hours: New rules, fresh vigilance

The ACGME's new work hour rules must be taken seriously by all involved.

Editorial. June 23, 2003.

There are some periods in life that are moaned and groaned through but remembered with great nostalgia -- even fondness -- once successfully survived. In the life of a physician, that period is medical residency, notorious for its intense workweeks that leave little time for sleep or social life.

In 1984, residency became infamous in the annals of patient safety as well, when the death of 18-year-old Libby Zion in a New York hospital focused the spotlight on the number of hours residents routinely worked and its effect on their judgment and effectiveness. The result of a grand jury investigation into Zion's death was a New York law passed in 1989 that set limits on the number of hours residents can work.

Beginning July 1, teaching hospitals in the rest of the country will be operating under similar standards when the Accreditation Council for Graduate Medical Education's new resident work-hour rules go into effect. Every accredited teaching hospital in the nation will be required to follow the rules or face a threat to its accreditation status.

The rules call for residents to work no more than 80 hours a week, averaged over four weeks, and have one day off out of seven, averaged over four weeks. They also require a 24-hour limit of on-call duty with an additional six hours allowed for the transfer of patient care. Residents can have on-call duty no more than every third night, with at least one consecutive 24-hour duty-free period every seven days, averaged over four weeks.