Working hours for residents focus of national scrutiny

GREENVILLE, N.C.   (Sept. 5, 2002)   —   By the end of September, Dr. Darnell Jones will know how much tweaking he and the graduate medical education policy committee will have to make to bring the 24 residency programs at Pitt County Memorial Hospital and the Brody School of Medicine at East Carolina University into compliance with new national guidelines.

The national Accreditation Council for Graduate Medical Education has addressed concerns raised over excessive duty hours for medical residents with a plan to limit their work hours and on-call schedules.

Jones, assistant dean for graduate medical education and professor of obstetrics and gynecology at the medical school and director of graduate medical education at PCMH, said that the ACGME has passed out its recommendations to residency programs across the country for comment. One of the biggest proposed changes would be a set number of scheduled work hours for a resident: no more than 80 each week, averaged over a four-week period. Also, a resident would have one day out of seven free of patient care, averaged over four weeks and a minimum of 10 hours of rest between duty periods.

One amendment might be that a medical specialty on a national basis could ask the council for a 10 percent increase, meaning that a workweek could increase to a maximum of 88 hours.

“In late September, the council will meet again to set the regulations, and we think it will look a lot like the proposal,” Jones said. When the final rules are written, the council will vote to make them effective most likely beginning in September 2003 to give the programs a year to take action, he added.

At PCMH and ECU, Jones said he doesn’t foresee any problems bringing the 24 residency programs and their 280 residents into compliance.

“Each of our programs are as different as your children,” Jones said. “For example, some residents have a 40- to 60-hour workweek now with no on-call, but for other residents it’s about a 110-workweek with on-call and heading back into the O.R. the next morning.”

For residencies where training is very procedure-oriented, like surgery and obstetrics, and those with critical-care rotations, what changes will be made to bring them into compliance are unknown at this time, he said. “The question will be can we squeeze the minimum (training) into an 80-hour workweek. We won’t know until we try. Some programs may need to expand their training schedule but we won’t know that for years,” he said.

For clinical instructor and chief resident for pediatrics, Dr. Roytesa “Roy” Savage the idea of cutting back on resident work hours and still learning all one needs to know to be a good pediatrician is a little daunting. “Just coming out of my residency, I think it’s going to be hard to (reduce work hours) and gain the experience you need to be a pediatrician,” she said. “Our residency is three years now, and we’re compressing all of the instruction into those years.”

Dr. Lorrie Basnight, residency program director for pediatrics and chief of staff-elect at PCMH, said bringing residency programs into compliance will be a work-in-progress for a while. “All of the program directors are in the process of reviewing their current work hours and developing plans to make sure that all programs are in compliance with the new work hour guidelines,” she said.

For some programs, national educational guidelines will have to be adjusted. Basnight pointed out for some residency programs educational guidelines would conflict with the proposed work-hour guidelines; those issues have yet to be resolved at a national level.

But Jones is confident that the PCMH-ECU residency program won’t face a huge overhaul when the final changes are mandated. “Overall, we’ll have to address bits and pieces of our program, but I don’t foresee a great change in the way we’re going to train residents,” Jones said. “We’ll have to wait until late September.