Resident Duty Hour Limits Pinch Training Programs

Family medicine residency programs have eliminated post-call clinics, instituted night-float systems and, in a few instances, hired additional staff members to cope with new rules implemented in 2003 that restrict the number of hours medical residents can work. Whether those changes can compensate for the reduced educational opportunities for residents and increased workload for attending physicians remains to be seen, according to research in the December issue of Academic Medicine.

The abstract for the article, "Training on the Clock: Family Medicine Residency Directors' Responses to Resident Duty Hours Reform," notes that researchers asked family medicine program directors for their opinions about the restrictions on resident duty hours (PDF file: 3 pages / 8.4 KB. More about PDFs.) imposed by the Accreditation Council for Graduate Medical Education, or ACGME, in 2003. Principal investigator Lars Peterson, an intern at the AAFP's Robert Graham Center in Washington, and his co-authors found

"The duty hours have resulted in more work for faculty and less teaching," said Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education and a co-author of the article. In keeping with the ACGME rules, residents must depart at the end of 24 to 30 hours on duty, leaving attending physicians and faculty to complete patient care or administrative tasks.

In addition, Pugno noted, the duty hour restrictions are adding economic pressure to family medicine residency programs already struggling with financial constraints. "Almost no programs have hired new faculty to compensate for the additional workload on faculty," said Pugno.

Indeed, said the study's authors, 77 percent of family medicine programs had not hired additional faculty or staff members in the first year after the new restrictions were implemented, despite faculty members' increased patient care and administrative responsibilities.

In an effort to adjust to duty hour restrictions, nearly 60 percent of programs eliminated post-call clinic duties for residents, and one-third had adjusted work schedules or created a new night-float system, according to the research.

"When they do that, their residents' continuity clinical hours often go down," said Pugno.

Program directors in the study expressed concern about decreased educational opportunities and quality, decreased continuity of care, inadequate preparation for real-world practice, development of a "punch-clock mentality," erosion of professionalism, and increased administrative burdens.

Family medicine isn't the only specialty grappling with new resident duty hour restrictions. In previous studies, neurosurgery, otolaryngology head and neck, pediatric, and surgical residency program directors expressed concern that restricted resident duty hours had a negative effect on their programs, particularly on continuity of care. Most of those programs, however, hired additional staff to compensate for the extra clinical and administrative workload.