US Limits Set On Hours That Doctors-In-Training Can Work

NEW HAVEN, Conn. (AP)--Harried and exhausted medical residents may become a thing of the past under new national limits on how many hours doctors-in-training can work -a change in policy one doctor called a "revolution."

A national group that issues accreditations for teaching hospitals said Wednesday it approved the rules to reduce the risk of dangerous errors by sleep-deprived residents.

The rules from the Accreditation Council for Graduate Medical Education are the first national limits on the total hours medical residents in all specialties can be on duty. Total work weeks will be limited to 80 hours.

Doctors said the regulations will dramatically change the grueling training system.

"This will really require a revolution in the way residents' hours are structured," said Dr. Peter Herbert, chief of staff at Yale-New Haven Hospital, which was sanctioned by the council last month for overworking surgical residents.

Under the new rules, residents must get at least 10 hours of rest between shifts and cannot be on duty for more than 24 hours straight. The new standards can be exceeded by as much as eight hours for approved educational reasons.

The council retained standards set in the 1980s that say residents should get one day in seven off and should not be on call more often than one day out of three.

The new rules take effect in July 2003.

At hospitals around the country, there are often no limits on the total number of hours most medical residents can work in a week, though some specialties already impose 80-hour limits. Some doctors-in-training complain that they routinely toil more than 100 hours a week and are on call every other night.

"As much as it was traditional, it was not a good system. People have even commented on the idea that it contributes to the dehumanization of doctors-in-training," Herbert said.

But some hospitals and doctors questioned how residents will be able to get all the training they need under the new rules. They also said it could cost teaching hospitals millions of dollars to hire more doctors.

Many older doctors believe such trial-by-fire training allows residents to follow patients more thoroughly and teaches physicians to make hard decisions when they are fatigued and under pressure.

The accreditation council said the new rules are a response to changing demands on doctors. Doctors are putting patients through batteries of new tests that did not exist decades ago. At the same time, hospitals have cut back on nurses and support staff, so residents often end up doing paperwork and other mundane tasks.

An 80-hour week already is standard for residents who are studying to become emergency room doctors, said Dr. J. Brian Hancock, vice president of the American College of Emergency Physicians.

"We've come a long way in realizing that the health and well-being of residents is absolutely critical to our learning process," he said.

The council can punish teaching hospitals by withdrawing its accreditation, a move that can cost the institutions students and millions of dollars in federal funding.

The Association of American Medical Colleges endorsed the new rules and said it would urge hospitals to comply. The group said, however, it must study how much the standards will cost.

The American Medical Association is scheduled to issue its own recommendations next week.

The Committee of Interns and Residents, a residents union, approved of the new requirements but said they will be difficult to enforce. The group has backed legislation in Congress to put 80-hour workweeks and other resident benefits into law.

New York State already limits medical residents to 80 hours a week and no more than 24 hours at a stretch -restrictions prompted by the death of a patient named Libby Zion in New York City 1984.

Zion died at New York Hospital-Cornell Medical Center after being admitted with a high fever. A grand jury determined that long hours worked by unsupervised residents and interns contributed to her death.

The council said it would act more quickly to sanction violators, and had been cracking down on hospitals that violated its old standards. Last year, the council cited 18% of the programs it reviewed for overworking surgical residents.

Updated June 13, 2002 3:25 a.m. EDT