Unintended Consequences: The Accreditation Council for Graduate Medical Education Work-Hour Rules in Practice

Seventy-nine-year-old Doris K. was admitted to the hospital with weakness at a bad time for my team and me, especially considering the limits of the new 80-hour workweek. It had been a frenetic day. We were swamped with 11 patients who came before Doris K., and her weakness brought us to a dozen. Keeping up was exacting, made worse by the pace: Six new admissions hit the floor in just 3 hours. As one of the interns succinctly put it, we were “getting spanked.” But in addition to the volume of admissions, our night felt increasingly overwhelming from a unique and novel burden: We had to finish everything by 11:00 p.m. Each of us did the math and tried to conceive of a method of seeing 5 more patients and leaving the hospital in the next two and a half hours. It couldn't be done, and realizing this made us feel exponentially more frazzled, rushed, and suffused with fatigue. This was medical training under the mandatory work-hour restrictions for physicians.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) announced new regulations for residency programs in the United States. Under these rules, all doctors in training must work fewer than 80 hours total in a week, cannot work more than 30 hours in a row, and should have 10 hours off between each shift. The regulations were developed because patients, community leaders, and physicians felt that the training system deprived young doctors of sleep and placed patients at risk. For many residents, the implementation of the ACGME rules this past July was dramatic, resulting in paradigm changes in the structure and function of house-officer teams on the wards. The pressure to comply has been substantial, with at least one program this year sanctioned for violating work-hour rules.

My class …