Johns Hopkins penalized for resident hour violations

Internal medicine residency is threatened with loss of accreditation.

By Myrle Croasdale, AMNews staff. Sept. 15, 2003.

The Accreditation Council for Graduate Medical Education has disciplined its first resident program for work-hour violations since new rules went into effect for all programs July 1. Johns Hopkins Hospital's internal medicine program was cited for exceeding the 80-hour workweek and requiring call more than every third night in the intensive care, counter to ACGME work hour standards.

As a result, accreditation will be withdrawn July 1, 2004, unless Hopkins complies with duty-hour limits.

Health policy watchers say the severity of the penalty -- loss of accreditation instead of the more typical probation -- signals that the ACGME is serious about enforcing work-hour rules and is conscious that failure to do so invites government oversight.

While the ACGME said it wasn't attempting to make an example out of the prestigious Johns Hopkins program, several residents and program directors said that was the effect.

"This will get the word out there that if they won't make special favors for Johns Hopkins, they won't make special favors for anyone," said Maurice Sholas, MD, chair of the AMA Resident and Fellow Section.

Ingrid Philibert, vice president of field operations for the ACGME, said two other programs had faced summary withdrawals of accreditation in the past 18 months and that, while unusual, the action was not unprecedented. Philibert pointed out that although July 1 marked the day when work-hour standards became mandatory for all programs, internal medicine as a discipline has had work-hour limits since 1988.