Residency Roundup: Duty Hours

I have noticed several reoccurring questions on our LDW facebook group about residency!  LDWblog is a perfect platform to provide answers that will be helpful to current and future resident wives. 

This week there was some questions/concerns about residency work hours and restrictions.  While I'm sure there are differences between how each specialty applies the rules, I wanted to post and dissect the real ACGME 2011 regulations for your guidance and information.
http://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-ComparisonTable2003v2011.pdf

Here are my 'favorites':

-Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.   http://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-faqs2011.pdf  for more information in their FAQs.  You get desensitized to the 80 hour weeks!  Its the weeks that push that four week average up that are brutal.  I overheard someone who works for the state department, joyously talking about how much overtime pay they received for working only 52 hours...wouldn't that be something!  The second link to the FAQs has some great followup examples and explanations.  I personally did not expect all the Journal Club, Dissection Lab, Tumor Board type meetings that keep DrH away from home that is not added into the '80-hour work week'. 

-A Review committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale. So what programs cannot justify the 88 hours? Although they are suppose to get permission first;)  I know of a program (not ours, I promise) that keeps to the 80 hr average but has 'volunteer shifts' that put the intern hours way above regulations.  

-Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks).  At-home call cannot be assigned on these free days.  Four a month.  Are weekends really two days long??

- Duty periods of PGY1 residents must not exceed 16 hours in duration.  Seemed like a good idea.  But it makes the other PGY years make up for the hours.  PGY2 was not awesome.

-Duty periods of PGY2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.  Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities.  Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00pm and 8:00 am in strongly suggested.  I find this standard a tad humorous... strategic napping...where and when does that fit in? At the computer? On an extra gurney? Haha...who likes to nap when your ridiculously loud pager can and will go off at any minute? 

- It is essential for patient safety and resident education that effective transitions in care occur.  Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.  This is a huge one!  Although, it covers practically any variable that could keep DrH at the hospital, it defines what their real job is: patient care and learning.  They cannot leave after stitching up half an ear, or ditch the last clinic appointment because time is up!


Hopefully, as this year moves along we can focus on the time together and less on time apart!  

Cheers!

Cami