Letter Responding to ACGME's False Claims on Resident Work Hours
January 9, 2003
This letter is in response to the editorial "Residents' Hours of Work" which appeared in the November 23, 2002 issue of the British Medical Journal.
According to Philibert of the Accreditation Council for Graduate Medical Education (ACGME) and Barach, under new proposed rules on resident work hours from the ACGME “residents will work no more than 80 hours per week [and] have shifts that are no longer than 24 hours.” These claims are false.
In fact, the ACGME proposal allows programs to comply with the claimed 80-hour limit by averaging over a four-week period. Obviously, this does not preclude work weeks of 110 hours, or even more. In addition, the 80-hour limit can be increased to 88 hours if a residency program can present an undefined “sound education rationale” to its own Graduate Medical Education Committee.
The 24-hour shift limit is similarly porous. The proposal actually permits six hours after the first 24 for transfer of patient care, educational debriefing, didactic activities and even for post-call continuity clinics; in other words, business essentially as usual. It also seeks to prevent disclosure of offending hospitals to trainees, patients and physicians.
Despite decades of controversy over this issue, the ACGME failed to take any significant action until threatened by legislation in Congress and regulation through the Occupational Safety and Health Administration based on evidence that long work-hours are associated with car accidents, depression and adverse pregnancy outcomes in residents. Neither of these proposals has the loopholes described above. The ACGME even failed to adequately enforce its previous weak policy, often failing to issue citations to violating programs and giving programs years to comply. While the ACGME’s voluntary self-regulation proposal may insulate residency programs and hospitals by keeping the government at arm’s length, it will do little to protect the patients and physicians endangered by current work practices.
Peter Lurie, M.D., M.P.H.
Sidney M. Wolfe, M.D.
Public Citizen’s Health Research Group
 Accreditation Council on Graduate Medical Education. Proposed Resident Duty Hours Language. Available at: http://www.acgme.org/new/resHrsLanguage.asp. Accessed 24 December, 2002.
 Patient and Physician Safety and Protection Act. Available at: http://thomas.loc.gov/. Type in bill numbers HR 3236 or S 2614.
 Gurjala A, Lurie P, Haroon L, et al. Petition to Occupational Safety and Health Administration, April 30, 2001. Available at: http://www.citizen.org/hrg1570. Accessed 24 December, 2002.
Competing interests: The authors are among the signatories to the OSHA petition referred to in the letter.