Medical Residents Limited to 80-Hour Week?

hipplayer

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    CHICAGO (Reuters) - Doctors-in-training in the United States--who work marathon shifts and 120-hour weeks that critics say lead to medical mistakes--cannot work more than an average of 80 hours a week, a body that accredits medical residents said on Tuesday.

    Under new rules approved by the nonprofit Accreditation Council for Graduate Medical Education, medical residents must also get one day off out of seven and a 10-hour rest between being on call and working a shift. The rules, which schools must follow to be certified, take effect July 1

    The vote by the council's board of directors means the standards "go from being a should, to a must" in order to pass muster with the accrediting body, said Julie Jacob, a spokeswoman for the group.

    Medical residents and the consumer group Public Citizen prefer federal standards, saying a private group lacks teeth to enforce the rules. But the government rejected a petition to a federal agency on that front last year.

    The Committee on Interns and Residents, a union that represents 12,000 residents in the United States, said the move "is going in the right direction, but the weakness is enforceability," according to executive director Mark Levy.

    Another flaw are loopholes that allow residents to extend, for example, the 24-hour shift limit by six additional hours, Levy said.

    The union is working to enact tougher laws on the state level, using a New York law as a model.

    Critics say medical residents are now overworked, clocking an average 120 hours per week, a situation they argue leads to medical errors and deaths.

    By making the standards mandatory, the accrediting group and the American Medical Association hope to head off federal legislation on residents' hours.

    Certification with the council is voluntary, but many medical colleges seek it for recognition, state board certification, and to qualify for federal Medicare funding.

    The group accredits about 7,800 medical residency programs involving about 100,000 trainees.
     
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    Moneyless

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      Originally posted by PelicanMan
      Its about damn time.

      However, I wonder how much of the medical mistakes are attributed to residents.

      Can anybody find out who makes the majority of the medical mistakes?

      Thanks alot.

      that would certainly be interesting
       

      Thewonderer

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        Originally posted by BrainDrain
        If residents are going to work fewer hours, who will pick up the extra workload?

        In some cases, unfortunately, med students pick up the extra workload. Remember that there is no LAW or UNION out there protecting med students. All you do then is whine to the Dean :p

        This is not a news anymore. This has been in effect for a while. But it is not until recently that they are cracking down on programs who violate this rule (read: Yale's generaly surgery program).

        I personally think that there is a lot of "wasted" time on the ward, where people sit around, waiting for labs to come back or patients to come in. I really don't think that it is hard to squeeze quality work time into 80 hours from 120 hours of non-efficient time. HOwever, that will require some serious changes in terms of shifts, resident evaluation, residency program educational objectives, etc. It is still a lot of growing pains....

        You also have to realize that attendings don't like the new rule because when they were residents, they had to work hard. Now that they are attendings, they want to enjoy the fruits and not get pulled into the hospitals because residents "have to go home now after 80 hours are up." Med students can also get pulled....:eek:
         

        Dr Chooch

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          Originally posted by BrainDrain
          If residents are going to work fewer hours, who will pick up the extra workload?

          I think residency directors should accept more residents into their programs so they can distribute the workload better. That'll give us a better chance of landing one of our top choices! :D Yeah baby!
           

          sweetfynesse

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            Originally posted by PelicanMan
            Its about damn time.

            However, I wonder how much of the medical mistakes are attributed to residents.

            Can anybody find out who makes the majority of the medical mistakes?

            Thanks alot.

            Residents do make clinical errors secondary to long work hours. However a recent study found that residents were more likely to harm themselves (ie falling asleep while driving...) than harming patients...
             

            BUmiken12

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              I interned at Southwestern this summer, and my roommate interned with their Hospital Administration staff. One idea that is being thrown around all across the nation is increasing the length of one's residency. It still sounds like a good trade-off to me, but it's a trade-off nevertheless.
               
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              MSTP boy

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                I am happy about the legislation. I do think that it is important for entering med students to be aware that there are also disadvantages to the new rules.

                It is not easy to argue that a surgical house officer will possess the same capabilities in 5 years working 120+ hrs/wk vs. 80 hrs/wk. Granted, some areas (ie NY) have already implemented these rules, but the long-term outcomes are still unpredictable. Basically, it shifts the bell of the learning curve out to the years of attending, and beyond.

                Not to say that there aren't loopholes in these rules. Also, most programs are accredited on a ~triannual basis, which means that they don't have to face accreditation audits for a few years anyway.
                 

                DukeBluDevl02

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                  I know this is a big jump and big success for residents, but is anyone else out there currently applying to med school still shaking their head...80 hours a week! That's twice full-time! I'm working full-time now and I'm tired now. I can't imagine doing twice as much, I'll go from tired to exhausted...oh well, just wanted to see if anyone else felt a little intimidated still..:laugh:
                   

                  HouseHead

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                    Very intimidated. But I know that it'll be worth it- I just know that I'll have to keep reminding myself why I'm subjecting myself to such extreme sleep/life deprivation. I pray that the 80 hr rule will get even more teeth before my time comes. Even better, that federal funding for GME will go through the roof, and then residency number *can* be increased!
                     

                    DrCarin

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                      I totally agree that the thought of residency hours is kind of scary! Some people really require a lot of sleep to be coherent, and they clearly cannot be getting while they're residents. But I also understand how important it is to immerse residents in their respective fields. It's a tough call really, but I think the benefits of shorter hours are going to far outweigh the decreased hours. Hopefully they'll have a better system worked out by the time we're residents, though I sometimes doubt it because the older doctors want us to go through the same thing that they went through!
                       

                      FireAway

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                        Medical students won't be picking up more of the load, that's absurd. As a MS, you can't write orders or sign discharge summaries. More of the work is being done by PAs, and that's a good role for them. Most hospitals are hiring more PAs to do the sort of BS paperwork that the residents used to do.

                        This is one of those things that sounds good in theory, the problem with it is that its just another unfunded government mandate created solely to "treat the headlines." Everybody has heard the stories in papers about sleepy residents messing something up, no need to repeat that here. They just went and limited the number of hours, without actually considering how this would impact the overall adequacy of training, the need to extend residencies to make up for lost hours, and better yet who pays for this (ends up falling to the hospital). The end result remains to be seen.

                        This rule also applies to surgical residents, not just medical.
                         

                        Saluki

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                          Eighty hours a week is intimidating, but think about college.
                          You're in class if you take several lab courses around 35-40 hours a week. Then, you spend 3 or 4 hours a night studying, and say 10 hours a week working or volunteering. That's 70 right there, and yet we still find time to get on this board:)
                           

                          ewsmith1

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                            Actually all programs are given a leeway of 10%, which would really mean 88 hr/wk.

                            As well, why would you want to work less hours during your residency and lose valuable time learning; hell, residency is where you need to gain the knowledge to help you treat your patients with confidence on your own.

                            Sure, 48 hrs on-call is extreme, but 90-100 /wk is not that bad for a surgical resident. Anyway, if you pick FP, PEDS, or some other non-surg specialty, you should have no problem meeting the 80/88 hour requirment.
                             

                            Thewonderer

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                              Originally posted by FireAway
                              Medical students won't be picking up more of the load, that's absurd. As a MS, you can't write orders or sign discharge summaries. More of the work is being done by PAs, and that's a good role for them. Most hospitals are hiring more PAs to do the sort of BS paperwork that the residents used to do.

                              Some hospitals don't hire more PA's. They are expensive. Med students are free. They can't write orders or sign discharge papers, but they can fill them out and get signatures from the upper-level residents. They can fill out paperwork as well as PA's. Med students are being asked to do more work at some med schools, especially on weekends where instead of interns being paired up with an upper-level residents, they ask med students to come in and work with the residents while the interns get their mandatory day off.
                               

                              Mutterkuchen

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                                Originally posted by FireAway
                                This is one of those things that sounds good in theory, the problem with it is that its just another unfunded government mandate created solely to "treat the headlines." Everybody has heard the stories in papers about sleepy residents messing something up, no need to repeat that here. They just went and limited the number of hours, without actually considering how this would impact the overall adequacy of training, the need to extend residencies to make up for lost hours, and better yet who pays for this (ends up falling to the hospital). The end result remains to be seen.
                                If the medical training system would have addressed this problem themselves years ago, there would have been no need to "address the headlines." The fact remains that 80 hours a week is still nearly 14 hours day, six days a week. Personally, I don't care who pays for this. Residents are abused and given their current workload and responsibility should be making more money, at least as much as the nurses.
                                 

                                Thewonderer

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                                  Originally posted by JBJ
                                  If the medical training system would have addressed this problem themselves years ago, there would have been no need to "address the headlines." The fact remains that 80 hours a week is still nearly 14 hours day, six days a week. Personally, I don't care who pays for this. Residents are abused and given their current workload and responsibility should be making more money, at least as much as the nurses.

                                  I think that people have to realize that residents comprise a small part of the MD's out there. Most of the MD's are attendings and they were trained in the older systems. They have paid their dues during their gruesome residency, handling 5 people's works by themselves and now it is their time to rip the benefit of their suffering. So why should the "current" residents get pampered and go home early while they, the attendings, are being pulled into the hospitals to help out? These attendings will of course fight the system and are the majority of the MD's out there.

                                  This is basically what is happening to the upper-level residents v.s. interns. At this transition time for implementing 80-hour work week, interns are at the center of attention. When the inspectors drop by the hospitals, they ask for intern's schedule (eventually, the focus will be on all residents and not just the interns, but for now, they want to right the interns who have traditionally been abused "the most" before righting the rest of the residents). And you can hear all the upper-level residents screaming already, "When we WERE interns, we HAD to work 120 hour week so why now I am working 100 hours so interns can go home after 80 hours. When we were interns, our upper level residents always go home before we do, but now we actually go home later than the interns. This is not fair!"

                                  And just imagine that the same scenario being applied to attendings v.s. residents, except on a larger scale.
                                   

                                  HouseHead

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                                    Originally posted by mashce
                                    Eighty hours a week is intimidating, but think about college.
                                    You're in class if you take several lab courses around 35-40 hours a week.

                                    :eek: Where did YOU go to college??? The only way I would have spent that much time in class would have been in the SUMMER, if I took Orgo lecture AND lab!
                                    Studying is an entirely different ball of wax... :laugh:
                                     

                                    HouseHead

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                                      Originally posted by ewsmith1
                                      As well, why would you want to work less hours during your residency and lose valuable time learning; hell, residency is where you need to gain the knowledge to help you treat your patients with confidence on your own.

                                      The assumes that the learning curve allows for a substantial increase in learning during the increased hours. From what I've heard/seen, it's the opposite- the increased hours degrade the quality of learning significantly, even when a resident isn't nodding off during something critical. And, of course, that nodding off or even decreased attention HURTS PATIENTS.
                                      Immersion one's field doesn't have to equal drowning in it.
                                       
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