The Effects of Work-Hour Limitations on Resident Well-being, Patient Care, and Education in an Internal Medicine Residency Program

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) work-hour limitations (WHLs) were implemented in July 2003. These limitations specify that resident physicians may work no more than 80 h/wk (averaged across 4 weeks) and no more than 24 consecutive hours (with 6 additional hours for transfer of care and educational activities), must have at least 24 consecutive hours off per week and at least 10 consecutive hours off between shifts, and may take call no more frequently than 1 night in 3.¹ The WHLs represent a profound change in physician training and provision of health care at teaching hospitals. Although the ACGME Residency Review Committee for Internal Medicine previously required a limit of 80 h/wk, compliance was imperfect nationally. Among internal medicine residents, more than half of the interns reported working an average of greater than 80 h/wk before the implementation of WHLs.²