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ACGME Duty Hours

Revision as of 18:25, 16 March 2011 by Mardigras (talk | contribs) (→‎New ACGME Work Hour Regulations 2011)
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New ACGME Work Hour Regulations 2011

  • To view the new proposed guidelines (which will take effect July 1, 2011) you can visit the ACGME website
  • Some recent discussion on concerns with the new duty hours is written in a GME e-letter from the AMA. Here is the link. http://www.ama-assn.org/ama1/pub/upload/mm/40/gme-03-2011.pdf
    • Check out the editorial by Dr. Rockey (the link is on the website above). It is an article in the Mayo Clinic Proceedings that discusses the duty hours. It doesn't really specifically address some of the questions we had but discusses duty hours in general. You may find it interesting.
  • There have been questions raised as to how this will impact pathology. The bottom line is we aren't sure yet. The ACGME Reference Committee for pathology is appealing several proposals by the ACGME committee because pathology is so different from other specialties. Here are a few examples.

Levels of Supervision

  • VI.D.3. Levels of Supervision. To ensure oversight of resident supervision and graded authority and responsibility, the program must use the following classification of supervision:
    • VI.D.3.a) Direct Supervision – the supervising physician is physically
    • present with the resident and patient.
    • VI.D.3.b) Indirect Supervision:
      • VI.D.3.b).(1) with direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision.
      • VI.D.3.b).(2) with direct supervision available – the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.
    • For pathology, there would need to be a definition of who specifically could supervise, i.e. a pathology assistant, senior resident, fellow, etc… Also how many procedures ect..would be needed in order for the specified person need to be adequately trained in order to supervise.'''''

Duty Hours

  • VI.G.4.a) Duty periods of PGY-1 residents must not exceed 16 hours in duration.
  • Can first years even take home call? See controversy below under home call...
  • Assuming they can... the main issue with this rule is that presently there is no exception made for our specialty who takes home call. So essentially it would be up to individual programs to decide how to make this rule work for them. If a first year resident is on call they will not be able to come back in the hospital if needed at night if they have exceeded their hours. Some options are have 1st years come in at noon and stay till 4 am, or the first years won’t take call at all. Problem with 1st years not taking call is that they wouldn’t be exposed to various call situations, especially on CP call or in programs with busy apheresis services. It would back up call onto 3rd and 4th years. ACGME reference committee for pathology is looking to petition to counter this amendment for the specialty of pathology, however earliest ruling would be in February and the latest would be April, but wouldn’t be finalized till June

Home Call

  • Just to be clear, home call does NOT count towards duty hours unless you have to come in to the hospital. At least for upper levels. For first years it may be a little more murky... see below...
  • Another thing to note is if you do have to come in on home call, this does NOT initiate a new minimum time off between duty periods. (The minimum for first years and "intermediate" levels is 8 hours).
  • Our associate program director is telling us that 1rst year residents cannot be on call starting the 2011/2012 academic year. If you will go to the ACGME website www.acgme.org and click on Duty Hours in the left hand column and then click on FAQs (which is the third section under new ACGME rules for July 2011), look at the bottom of page 7 and the top of page 8, It says: Question: Can PGY-1 residents take at-home call, and if so what are the work-hour restrictions for this? Duty Hour FAQs 7 Answer: PGY-1 residents are limited to a 16-hour shift and are not allowed to take at-home call. To my understanding many pathology programs are not making any changes concerning 1rst year residents taking home call (of coarse always under supervision). Are other pathology programs following this?
    • Response: Thanks for pointing this out. You're right according to the FAQ. However, according to the actual duty hours approved standards themselves, this is not stated clearly in my opinion. The standards say "Duty periods of PGY-1 residents must not exceed 16 hours in duration." However, duty periods were never clearly defined, at least that I could see.
    • When I spoke to a member of the RRC committee she also agreed that the wording is unclear. I believe that this is an issue that is being appealed by the Pathology RRC committee. I will talk to a member of this committee and clarify the details.
    • As far as whether programs are following this, unless the RRC committee is successful in getting pathology exceptions to this rule, I know for a fact that our program director will be following these rules. I can't speak for other programs, but she is a stickler for these rules, and rightfully so, even though she may not agree with them.

Solutions?

  • Wish there were easy ones... I guess we gotta prepare for the worst...
  • For CP or frozen call assuming first years can't take home call
    • Have first years come in late... say noon... and take their 16 hours of call so they get some exposure. Then have a backup upper level finish the night.
    • Backload call for upper levels
  • For CP or frozen call IF first years CAN take home call
    • Have them take the home call, but arrange a backup upper level if they have exceeded their 16 hours and have to come in for frozen, apheresis, etc. They can still answer the CP call pager as long as they don't have to go in to the hospital.
  • Autopsy call
    • As long as a program has a cutoff time (ours is 2 pm on weekends, and they wouldn't call us before 7 or 8 am), that is not a violation of duty hours.
    • Even if a first year (or upper level for that matter) takes a whole weekend of autopsy call, as long as they have the next weekend off that is not a violoation. (A day off per week AVERAGED over 4 weeks).

Comment

Our associate program director is telling us that 1rst year residents cannot be on call starting the 2011/2012 academic year. If you will go to the ACGME website www.acgme.org and click on Duty Hours in the left hand column and then click on FAQs (which is the third section under new ACGME rules for July 2011), look at the bottom of page 7 and the top of page 8, It says: Question: Can PGY-1 residents take at-home call, and if so what are the work-hour restrictions for this? Duty Hour FAQs 7 Answer: PGY-1 residents are limited to a 16-hour shift and are not allowed to take at-home call. To my understanding many pathology programs are not making any changes concerning 1rst year residents taking home call (of course always under supervision).

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