Resident work-hour limits still a struggle one year into restrictions

General compliance appears to be the norm, but residents see flaws in the system.

By Myrle Croasdale, AMNews staff. July 19, 2004.

First-year family medicine resident Julie Silverhart, MD, says that, for the most part, her hours at Greater Lawrence Family Health Center in Lawrence, Mass., fall within the standards set by the Accreditation Council for Graduate Medical Education. But she also acknowledges that during her first month in internal medicine, she worked more than the average of 80 hours per week allowed under the guidelines.

Dr. Silverhart's experience is fairly typical as residents and programs adjust to the work-hour limits that went into effect in July 2003. Residents say programs are in compliance for the most part, but sometimes they are not.

ACGME enforcement of the regulations has garnered mixed reviews. The Committee of Interns and Residents, a staunch critic of the ACGME, is skeptical of programs and resident claims that they are mostly in compliance. All involved, including ACGME officials, acknowledge that the guidelines have had some negative consequences and that there have been intentional violations of the work-hour standards.

But overall, ACGME Executive Director David Leach, MD, said the response from programs had been amazing.

"We think the community has risen to the challenge," he said. "They are taking it seriously."

The new standards require all residents to work no more than 80 hours per week, averaged over a month, with call no more than every third night.

In-hospital call is limited to 24 hours with an additional six hours for patient transfers and educational activities. One day off out of seven, for an average of four days off a month, also is required.