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Relief in Sight for Sleep-Deprived Medical Residents

Medicine: An 80-hour workweek for in-training doctors is expected to cure some ills in patient care.


Many doctors-in-training will see their long work hours cut back under new standards approved Wednesday by a group that accredits teaching hospitals.

The move to ease the strain on sleep-deprived residents comes as concern is growing over medical errors in hospitals. With no limits nationwide on residents' schedules, some work 120 hours a week or more. Shifts vary from hospital to hospital and often between specialties within the same hospital.

"I've fallen asleep with my hands in a woman's vagina delivering a baby because I was so tired," said Dr. Angela Nossett, chief resident of the department of family medicine at Harbor-UCLA Medical Center and vice president of the Joint Committee of Interns and Residents.

Under the new rules set by the Accreditation Council for Graduate Medical Education, residents are to work a maximum of 80 hours a week with 10 hours off between shifts and one day off per week. Hospitals' accreditation--required for federal funding--can be jeopardized if they break the rules, which will take effect in summer 2003.

Health-care providers agree that there is a correlation between the number of hours resident physicians work and the number of errors they make.

"Errors are not being tolerated by consumers any longer," said Jim Lott, executive vice president of the Healthcare Assn. of Southern California. "Hospitals can pay more upfront now or pay more later in terms of getting licenses or accreditations revoked, or lawsuits filed."

Last month, 200,000 medical residents filed a class-action lawsuit in federal court accusing seven medical associations and 35 teaching hospitals of rigging the system that determines where medical school graduates will train, how much they will be paid and how many hours they will work.

The accreditation council said residents were spending too much time doing work that can be done by others, such as drawing blood or transferring patients, instead of concentrating on their medical education. The council accredits 7,800 residency programs nationwide and guides training for 100,000 residents.

"More time should be spent with patients, in educational conferences and learning the craft of being a physician," said Dr. David Leach, executive director of the organization.

Similar recommendations from the Council on Medical Education will be reviewed at the American Medical Assn. conference in Chicago this weekend. The AMA is set to decide early next week whether to recommend an 84-hour workweek, averaged over two weeks. The AMA recommendations would apply to any hospital, accredited or not, but are not enforceable.

New York is the only state to issue regulations governing resident work hours. In 1989, the state adopted rules limiting residents to an 80-hour workweek.

A change is overdue, several medical residents said Wednesday.

"We can't give our patients optimal care; our own quality of life is being affected," said Dan Schaefer, a second-year resident in Harbor-UCLA's family medicine department. "The system needs to change for two reasons: so physicians can live somewhat reasonable lives and we can provide quality care to our patients."

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