Proof of Massive ACGME Duty Hour Standard Violations
Whether you want to believe it or not, many training programs are in violation of the ACGME duty-hour standards. I’ve known this all along, primarily from talking with many people in residency that I keep in touch with on a regular basis.
The AMA has released a study that basically proves that the work hour standards are one big piece of political bullshit.
The study was a monthly web-based survey, and polled residents preimplementation and postimplementation of the work hour standards. The residents taking part in the survey completed 29,477 reports of their work and sleep hours.
Violations were reported during 3765 (44.0%; 95% CI, 43.0%-45.1%) of the 8553 intern-months assessed postimplementation (including vacation and ambulatory rotations), and during 2660 (61.5%; 95% CI, 60.0%-62.9%) of 4327 intern-months during which interns worked exclusively in inpatient settings.
There you have it, folks. Nearly half of all months had violations during ambulatory settings and nearly 62% of months had violations where interns were working on inpatient services.
The ACGME needs to start cracking some balls if they want programs to take these duty restrictions seriously. If nothing is done, or programs are simply slapped on the wrist, the system will continue to be abused and work hour restrictions will be nothing more than fudged numbers on some slip of paper in the program director’s office.
via: [JAMA]
What do you think will actually be done?
I don’t know, but I hope (for residents’ sake) that these violations are taken seriously and programs start getting slapped with punishments.
jama, huh? great post!
I bet these violations are grossly underreported and the real percentage is much higher. For surgery, it’s probably more than 95 percent.
Probably so Zuwie. The study didn’t state which specialties were polled. With “ambulatory” and “inpatient” services, though, it sounds as if the bulk of the data came from medicine rotations.
With answers like what they are getting, they should dig further.
Who provides a solution? Protesting med students, some MBA who has a panic attack seeing that you are out of compliance? Once someone brings the to the attention of a supervisor or administrator, they become liable.
Some lawyer or budding politician needs to jump on this to make a name for his or her self.
Oh– and since we have a shortage of MDs in the US, and from what you say here about people being stretched beyond normal working conditions, why aren’t there more doctor slots? Med school attacks the best– excuse me, ATTRACTS the best– it’s not like each school admitting ten more students will be scraping the bottom of the intellectual barrel.
During my surgery internship, we reported our work hours to the department secretary. I was hauled into the Program Director’s office where he and the Chairman of the department ORDERED me to lie on my hours report. I was to write no more than 80 hours on my timesheet. Apparently all the other interns were already doing that so I was the outlier who was actually telling the truth. I participated in the study you quote and I averaged 105-110 hours per week for 50 out of 52 of those weeks. The other 2 were vacation.
“A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.”