Rules give young doctors limited workweek, more rest

The group that oversees doctor training in the United States announced Wednesday it will impose strict new limits on work hours for medical residents in response to mounting evidence that workweeks of up to 120 hours were detrimental to young doctors and perhaps their patients as well.

The first national standards address long-standing concerns that the grueling hours trainee physicians work endangers patient care, an issue that has recently received new attention because of reports that thousands of people die annually from medical mistakes.

Under rules adopted by the Accreditation Council for Graduate Medical Education, the normal resident workweek would be limited to 80 hours. The standards also impose mandatory rest periods of 10 hours between shifts, one day a week off, restrictions on moonlighting and closer faculty supervision.

Some states and individual hospitals have in recent years implemented restrictions on the number of hours that can be worked by residents, who perform a wide range of duties in hospitals-from performing routine tests to diagnosing and treating patients. But some have questioned how well those are enforced. And many residents continue to work in excess of 100 hours a week, often in shifts of 36 hours.

"Residents have more to do, in less time, with less support than ever before," said David C. Leach, executive director of the board, which oversee 7,800 residency programs involving 100,000 doctors nationwide.

Over the next 12 months, the accreditation council will take comments on implementation of the new standards and begin imposing sanctions on hospitals that violate them starting in July 2003.

The Association of American Medical Colleges, which in the past has opposed restrictions on residents' hours, Wednesday endorsed the decision. Association president Jordan Cohen acknowledged that given the increasing concern over the issue, some kind of regulations were probably a necessity. He did caution, however, that the group was concerned about the costs of the new regulations for hospitals.

The Committee of Interns and Residents, which represents some 12,000 unionized residents, applauded the decision. "Too many mistakes can happen when we're working 36-hour shifts and 120-hour weeks," said Ruth Potee, the group's president.

The subject of excessively long hours for young doctors came into the spotlight in 1984, when the death of 18-year-old Libby Zion was blamed by many on overworked, unsupervised residents.