August 28, 2003
IT DOESN'T TAKE a brain surgeon to understand the dangers of overworking young doctors who are in training: sleep deprivation, poor nutrition, medical mistakes. But implementing an 80-hour work week for residents might require the expertise of a professional just as highly educated.
It sounds simple, but it's a change that Johns Hopkins Medical Institutions and other teaching hospitals are grappling with. The Accreditation Council for Graduate Medical Education has cited Hopkins for violating work hour rules in its 106-resident internal medicine program, which could endanger the program's accreditation.
The rules, adopted by the Chicago-based organization, apply to the nation's 7,800 residency programs. A vice dean at Hopkins medical school characterized them as "extremely complex and subtle." A graduate dean at Duke University Medical School told The Sun's David Kohn that colleagues across the country are "struggling" with the new standards.
But, as published, the duty rules appear straightforward: Residents can't work more than an average of 80 hours a week over a four-week period; they must have one day out of seven free of clinical and educational duties; they can't be on call more than once every three nights, to name a few.
If the work rules are complex because they are onerous, that's one thing. But if they are onerous because implementing them would require hiring more staff, that excuse is no excuse. A panel mostly made up of physicians devised these standards. They recognized the implications of implementing them, costs that would be outweighed by patient safety, the well-being of the young doctors and the quality of education. Internal medicine residency programs nationwide have actually been operating under an 80-hour average weekly duty rule since 1988. The rules are not really that much stricter under the new standards.
The ACGME adopted the standards, which took effect this July, for good reasons: patient safety, the effect of excessively long hours on performance, and patient complaints. For far too long, residents and interns provided a source of cheap labor - all in the name of educating the best possible doctors. Physicians are an invaluable human resource. By the ACGME standards, they work an average week that is twice that of most Americans.
If the new standards pose a scheduling problem for Hopkins, we're confident that this esteemed medical institution will use its brainpower to rectify the situation, preserve the accreditation of its internal medicine program and turn out well-trained physicians. After all, 99 percent of its residents pass their medical boards.
Johns Hopkins says it "fully supports" the new work rules. We want to take it at its word.
