Recon

Work-hour restrictions have had unintended consequences for resident preparedness

In July 2003, the Accreditation Council for Graduate Medical Education mandated that resident physicians at accredited medical training institutions in the United States could work no more than 80 hours per week, averaged over 4 weeks. In addition, residents were limited to no more than 24 hours of continuous duty, plus up to 6 more hours for continuity of care, one day off per every 7 days, and no more than one in-house call per every 3 nights averaged over 4 weeks. In July 2011, it was further mandated that post-graduate year 1 residents could work no more than 16 hours in a row, with a mandatory rest period of 8 hours, with 10 hours recommended, between duty periods.

The 80-hour work week mandate was established mainly out of concern for patient safety, due to the perception that residents were overworked and fatigued, resulting in poor decision-making, and ultimately, making medical errors that negatively impacted patient care. The Accreditation Council for Graduate Medical Education’s (ACGME) development of resident work-hour restrictions was the result of a variety of factors. However, a single unfortunate incident was certainly influential. In 1984, 18-year-old Libby Zion, daughter of lawyer and journalist Sidney Zion, died within 24 hours of admission to a hospital in New York City. Upon learning the physicians caring for his daughter overnight were resident physicians who were, in his opinion, overworked, Zion initiated a series of events, many through mainstream media appearances, which led to the development of resident work-hour restrictions in New York in 1989, and ultimately, the 2003 ACGME restrictions.

Contrived work-hour restrictions

During the past decade, there has been a significant increase in the number peer-reviewed published studies which have discussed the impact work-hour restrictions have had on patient safety, resident performance and confidence, the need for fellowships and the preparedness of residents to enter the “real world” after training. Resident preparedness is perhaps most critical to this discussion because once resident physicians graduate residency, they make clinical decisions, indicate patients for surgery and perform operations.

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