Resident duty hour restrictions create challenges for family medicine residency programs
FOR IMMEDIATE RELEASE: Friday, December 8, 2006
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The Robert Graham Center
Policy Studies in Family Medicine and Primary Care
WASHINGTON — Restrictions on resident duty hours have forced family medicine residency programs to eliminate post-call clinics, institute night-float systems and, in a few instances, hire additional staff members to cope with new rules implemented in 2003 that restrict the number of hours medical residents can work. That’s the finding in research published in the December issue of Academic Medicine.
According to a survey of 328 family medicine residency directors one year after the restrictions were put in place, 50 percent reported that the restrictions created increased patient-care duties for attendings, while 42 percent reported no increase. Furthermore, 60 percent of the survey respondents eliminated post-call clinics and nearly 40 percent implemented a night-float system. Common concerns among the program directors included administrative hassles and losses of professionalism, educational opportunities and continuity of care.
"The duty hours have resulted in more work for faculty and less teaching," said Perry Pugno, M.D., M.P.H., C.P.E., director of the American Academy of Family Physicians Division of Medical Education and a co-author of the article. "The duty hour restrictions are adding economic pressure to family medicine residency programs already struggling with financial constraints."
An additional concern of the program directors was that with less time spent in training, residents' time must be prioritized to enable quality learning experiences. The findings show that less time is spent participating in formal learning activities such as didactics and journal clubs, and the authors assert that this time must be made up somehow; otherwise, residents will enter the workforce without the necessary skills and knowledge to practice medicine.
The 2003 Accreditation Council for Graduate Medical Education (ACGME) regulations limit residents to an average of 80 work hours a week, with the length of a shift limited to 24 hours with up to six additional hours for continuity and transfer of care. In addition, the regulations require ten hours off between shifts and one day free of scheduled patient care per week.
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The Robert Graham Center(www.graham-center.org) conducts research and analysis that brings a family medicine perspective to health policy deliberations in Washington. Founded in 1999, the Center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians.
The information and opinions contained in research from the Robert Graham Center do not necessarily reflect the views or policy of the AAFP.
December 08, 2006