ACGME Duty Hours: Money 1st, Safety 2nd

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The earliest the ACGME will implement new duty hour rules is July 1, 2011, said Thomas Nasca, MD, MACP, during his presentation The Recommendations of the IOM Consensus Committee to Optimize Resident Hours and Work Schedules to Improve Patient Safety: Summary and Discussion at the 2009 ACGME Educational Conference.

However, depending on how greatly the new standards differ from the current ones, the ACGME could push that date back, Nasca added.

Either way, Nasca assured attendees that they will have plenty of notification to implement new rules prior to the effective date.

Here were some comments:

By Dennis Venable, MD on March 10th, 2009 at 10:37 am
There are repeated references in the IOM’s Dec report on duty hours, acknowledging the need for significant additional funding for GME in order to implement the recommendations contained their report. Their own estimates suggest an additonal annual amount needed of ~ $1.7 billion. Does Dr. Nasca anticipate that subsequent duty hour restrictions to occur as “unfunded mandates” similar to the original 2003 policy change?

By Julie McCoy on March 10th, 2009 at 11:05 am
Nasca and the rest of the ACGME are VERY aware of the costs associated with potential duty hour reforms. The $1.7 billion is the estimated cost to replace intern labor if the recommendations are put into effect. From what I understood at the conference, it does not account for the cost of replacing senior residents.

In his presentations, Nasca did say that they do not want to put undue financial burdens on programs or institutions or make this an unfunded mandate, especially in this economic climate. This is one reason why he encouraged programs trying to implement some of the IOM recommendations to loop the ACGME in on their findings– so that they could get a feel for costs associated with comply with the standards.

Everyone agrees that the public and regulators need education on what duty hour restrictions will mean for hospital funding, patient care, etc. Although Nasca said the ACGME would do all that it could to facilitate the necessary conversations, he did remind the audience that the ACGME is a nonprofit group, that cannot lobby Congress and others. He urged the GME community to communicate their concerns with their Boards and other professional organizations to get the word out there.

http://blogs.hcpro.com/residencyman...acgme-conference-4-duty-hours-implementation/
FYI here is a link to the changes that hospitals and program directors say they can't afford:
http://www.iom.edu/Object.File/Master/60/471/one pager revised for web 2.pdf

 

[dragonfly99]

I was totally in favor of the 80hours/week, 30/call reforms that were put in, but I'm not so sure about these new recommendations. I have worked both before and after the 80/week and I really think it helped the educational process (though I am not a surgeon and I know they may feel differently).
However, I think there has got to be some number of hours below which you really compromise the training...I can't imagine that surgical residents, or even IM residents, could work 40 hrs/week like in Denmark or something and still come out competent. I think you'd have to extend the number of years of residency, at the very least.

 

[Miami_med]

I don't want to be a test dummy. I don't think that we should implement sweeping reforms uniformally without some sort of proof that they would work. I tend to oppose top down orders on labor anyway, but at this point, there is nothing more than conjecture as to what benefit further restrictions would have. The current system seems to be working acceptably, but there is some real question as to whether further restrictions would improve anything. I appreciate time off, but I don't want to spend the next 5 years as part of some sort of national training labor experiment.

 

[dragonfly99]

I'm with you.
I don't want someone sending me home from my fellowship just because I worked 60.1 hours or something.

I think the original work hours limitations were overall a good thing, as some surgical programs worked trainees inordinate amounts of hours and doing things that weren't necessarily educational. However, in general I oppose externally-imposed work hour limits. I don't want someone sending me home in the middle of learning how to do a transesophageal echo, because some bean counter says I'm over the work hour limit for the month. I also think work hour limits are more important for interns, because they are the ones who tend to be up the entire night admitting patients, and with little time to eat, sleep etc. As you progress up the chain of command, you may still be "on call" but likely to be paged and/or called to go do things, only if it's really important.