Even as historic new restrictions on work hours for medical residents take effect today, the American Medical Student Association is pushing for federal legislation to close perceived loopholes in the rules.
The 40,000-member association on Monday reiterated its support for legislation from Sen. Jon Corzine (D-N.J.) and Rep. John Conyers (D-Mich.) that would codify the new Accreditation Council for Graduate Medical Education standards, which limit residents to 80 hours of duty per week and 24 hours per call period.
"Federal legislation is necessary to close loopholes in the new regulations and protect patients from medical errors made by resident physicians working long hours with little sleep," AMSA President Lauren Oshman, M.D., says in a written statement. "Patients have a right to know how long their doctor has been awake, but ACGME regulations would provide no public accountability to patients."
The student group says the guidelines do not require hospitals to inform the public of any violations of the new standards, nor do they provide for any civil penalties against violators.
Nearly 100,000 medical residents in 7,800 residency programs nationwide are covered by the ACGME rules that cap resident work schedules at 80 hours per week. Residents must be allowed an average of one day off per week over each four-week period and cannot be scheduled for in-house call more than once every three nights, again averaged over four weeks.
The infamous 36-hour call shifts also are disappearing, as call now is limited to 24 hours, though residents may remain on duty for up to six additional hours "to transfer patients, maintain continuity of care or participate in educational activities," according to the ACGME. Residents also are entitled to a minimum of 10 hours off after each duty shift or call period.
Starting in July 2004, residency programs may increase resident schedules to 88 hours under certain conditions.
AMSA says this exemption and the fact that limits are subject to four-week averages could result in some residents continuing to work 100-hour weeks.