 December 2002 • Volume 8 • Number 12 |
The Occupational Safety and Health Administration last month rejected a petition to restrict resident duty hours, choosing to rely instead on the Accreditation Council for Graduate Medical Education to address the issue. The petition was filed in April by the consumer watchdog group Public Citizen, the American Medical Student Association and the Committee of Interns and Residents.
The petition asked OSHA to impose a mandatory 80-hour workweek, one day off per week and shifts no longer than 24 hours. To read about the petition, go to http://www.citizen.org/pressroom/print_release.cfm?ID=1239.
The request was based on data linking long work hours to depression, motor vehicle crashes and adverse pregnancy outcomes. The data indicate that remaining awake for more than 24 consecutive hours produces cognitive deficits equivalent to those resulting from a 0.1 percent blood alcohol level, illegal for driving in most states.
Public Citizen contends that the ACGME's voluntary standards fail to adequately protect residents and their patients. The new proposed ACGME guidelines permit a 10 percent increase in hours if a residency can provide an "educational rationale" supporting the increase. Additionally, the ACGME can exempt entire specialties from compliance if national representatives of those specialties can demonstrate that residents cannot complete their educational activities without working more hours.
Furthermore, says Public Citizen, the ACGME has failed to enforce its current work hours guidelines. The council's new proposal makes no allowances for public disclosure of violations, and no civil penalties can be imposed against violators, an option if OSHA were to regulate.
Most of the points in the proposed ACGME standards jibe with the AAFP's evolving duty hours policy. The Academy encourages some flexibility to adapt work hour guidelines to the clinical and educational needs of individual residency programs while protecting patient care and safety.
The way family practice resident Janet Hurley, M.D., of Tyler, Texas, sees it, that flexibility needs to extend even beyond the level of the individual residency. To really get at the issue, she notes, you've got to distill it down to the individual call level.
"Not all call is the same," says Hurley. Often, she notes, where a particular resident is in the call-duty hierarchy contributes to what shifts he or she pulls. And don't forget that "long call" or "late call" doesn't necessarily translate to "grueling call" -- not if you spend most of your time sacked out on the sofa in the doctors' lounge.
"That's going to be a difficult thing for a regulatory body to determine," Hurley points out, "whether the call was hard enough to allow you to go home at noon."
Paul Watts, D.O., of Fort Worth, Texas, also a family practice resident, likewise supports flexibility in this aspect of residency training.
"I think it's important in a residency program that you get some training with training wheels on," Watts says. Knowing precisely what's expected of him and being aware of what his backup options are allow him to take full advantage of that training, he adds.
Legislation that would set federal limits on resident duty hours -- H.R. 3236 and S. 2614 -- came before Congress this year and may be reintroduced next year. Go to http://www.citizen.org/hrg/healthcare/articles.cfm?ID=8398 for a comparison of the various resident work hours proposals.
FP Report is published by the
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Copyright © 2002 by
American Academy of Family Physicians.