New Resident Regulations on the Horizon


The Accreditation Council for Graduate Medical Education (ACGME) task force is close to offering revised standards for medical resident work hours—a decision that could significantly change the landscape for academic hospitalist programs.

While no date has been set for the unveiling, a May 4 letter written by ACGME CEO Thomas Nasca, MD, MACP, says “the work of the task force is nearly complete.” Many expect the rules will be offered as a draft for public comment in the coming weeks. If approved, the new regulations would probably take effect in July 2011. ACGME formed the task force more than a year ago as the prescribed five-year update to the landmark 2003 duty-hour standards.

Medical experts say the new rules will in many ways mirror the recommendations of the Institute of Medicine’s 2008 report “Resident Duty Hours: Enhancing Sleep, Supervision and Safety.” The oft-quoted report recommended residents only treat patients for up to 16 hours during their shift, down from the current recommendation of 24 hours. It also suggests residents take an uninterrupted five hours for a continuous sleep period between 10 p.m. and 8 a.m.

Many HM physicians expect the new ACGME rules will include a 60-hour workweek cap, part of a growing trend to try to balance the educational requirements of medical school with the need to expose residents to practical experience. Dr. Nasca gave no hint as to what ACGME’s recommendations will be.

In an article in this month’s The Hospitalist, academic and community hospitalists say they have been keeping on eye on how the newest rules will change their playing fields: Will a wave of academics flee teaching hospitals, as additional clinical duties become an intrusion? Will teaching hospitals face financial pressure as they struggle to replace the lower-cost labor force that residents represent? And—perhaps most importantly from a medical perspective—will graduate trainees be as prepared as their predecessors when they enter practice?

“Hospitalists will always be involved in teaching—it will never go away,” says Julia Wright, MD, FHM, a member of Team Hospitalist and clinical associate professor of medicine and director of hospital medicine at the University of Wisconsin School of Medicine and Public Health in Madison. “But it will be a very different balance, a different kind of feel.”

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