Resident Work Hours
a. The American Academy of Family Physicians opposed government regulation of resident work hours.
b. The AAFP opposes 24-hour work limits on any other consecutive time constraints as these can compromise patient care and residency education as well as limit flexibility of scheduling within individual residency programs.
c. The AAFP supports the concept that the time residents spend delivering patient care services of marginal or no educational value should be minimized.
d. The AAFP supports maintaining the RRC-FM as the primary regulatory entity of the FMP residency standards, including resident work hours. However, the AAFP calls on the RRC-FM to institute more effective enforcement of these standards.
The development of further restrictions on work hours should consider the following:
- Accrediting organizations will commission research studies to more closely examine the hypothesis that further restrictions of resident duty hours would lead to improved clinical outcomes in various patient care settings.
- Accrediting organizations will not support further duty hours restrictions without the economic support necessary to prevent program closures due to resulting fiscal insolvency.
- Accrediting organizations will devise a process to assess periodic “technical violations” of the duty hours standards in those rare circumstances where the resident has made this choice in the patient’s best interest.
Physicians have an ethical duty to their patients and profession to provide safe, compassionate, quality medical care. These duties depend on a safe and healthy working environment for resident physicians. To this end, resident assignments must be made in such a way as to prevent excessive patient care responsibilities, inappropriate intensity of service or case mix, and excessive length and frequency of call contributing to excessive fatigue and sleep deprivation. The program must also ensure the following:
- Residents should have at least 24 consecutive hours free of all assigned duty every 7 days, averaged monthly.
- Residents should not be required to have overnight, on-call duty more frequently than one night in three, averaged monthly.
- Residents should not be scheduled to be on duty more than 80 hours per week, averaged monthly.
- There should be adequate backup if sudden unexpected patient care needs create resident fatigue sufficient to jeopardize patient care during or following on–call period.
Programs must have formal mechanisms specifically designed for promotion of physician well-being and prevention of impairment. There also should be a structured and facilitated group designed for resident support that meets on a regular schedule.
Residency programs should have written guidelines governing resident duty hours and should inform all resident of these guidelines.
Residents should have the right to confidentiality report work hour violations to the RRC-FP and each residency program should inform residents of this right. (March BOD 2002) (2010 COD)