Limiting Residents’ Work Hours to Impact Many Facets of BWH
Last year, the Accreditation Council for Graduate Medical Education (ACGME) approved new requirements that limit residents to 80 duty hours per week. These requirements will be mandated nationwide as of July 1, 2003. The resulting reduction of hours has the potential to impact the continuum of care and the responsibilities among members of any given patient care team at BWH—changes that BWH is well prepared to handle.
As residents’ hours will be cut significantly, plans are almost finalized at BWH to deal with the upcoming transition coinciding with the July 1 arrival of the 2003 newly matched residents.
“As a way to keep the patient continuum of care consistent and to ensure patient safety over time, BWH has come up with a plan to ‘back-fill’ those responsibilities, tasks, and workload that would traditionally be handled by residents,” said Chief Medical
Officer Anthony Whittemore, MD.
According to Whittemore, an incremental addition of full time employees will take place. As a result, a combination of nurse practitioners (NP) and physician assistants (PA) will be added to the staff of the areas that are predicted to be most affected by the upcoming ACGME requirements.
Plans include adding one NP or PA to the Emergency Department; four to the Bone Marrow Transplantation (BMT) Service; three to Cardiothoracic Surgery and two to General Surgery; one to Neurology; two to Neurosurgery; one to Obstetrics and Gynecology; and two to Orthopedics.
Also, more slots for residents and fellows were added to certain service lines and made available to this year’s medical school graduates in anticipation of the upcoming changes in July. These slots were in the areas of BMT, Cardiothoracic Surgery, Neurology, Neurosurgery and Obstetrics and Gynecology.
BWH Leading Surgeons Conduct Study Related to ACGME Requirements
Drs. Edward Whang, Stanley Ashley and Michael Zinner from BWH’s Department of Surgery co-authored a recent study with Michelle Mello from the Harvard School of Public Health that examined the implementation of resident work hour limitations in New York, where state regulations (similar to ACGME requirements) have already been enacted. The study findings were published in the April 2003 issue of Annals of Surgery and provide helpful lessons for BWH and other hospitals anticipating nationwide implementation of ACGME’s work hour requirements in July.
The researchers found that while a majority of general surgery residents in New York State reported improved quality of life as a result of the work hour limitations, a substantial portion reported negative impacts on surgical training and quality and continuity of patient care. In addition, negative perceptions were found to be more prevalent among senior residents and residents at academic medical centers than among junior residents and residents at community hospitals.
“The implementation of limiting a resident’s work hours to 80 per week in general surgery residents could have negative consequences for patient care and resident education,“ said Zinner, who served as the study’s senior author. “So we have worked to address those issues in our own planning.”
“As BWH planned to develop strategies for complying with ACGME requirements, these areas of concern were considered heavily. As a result, our plan provides a feasible solution by keeping patient safety and educating the next the generation of medical leaders as top priorities,” said Ashley, who serves as the director of Surgical Residency at BWH.