VALLEY HOSPITALS Rule capping hours medical residents can work takes effect

A local doctor said the rules make specialized training more difficult.
By JOHN SKENDALL
VINDICATOR STAFF WRITER
YOUNGSTOWN -- A new regulation for doctors-in-training went into effect this month, capping the number of hours medical residents can work at 80 per week.
The new rules also limit to 24 the number of consecutive hours a medical resident may work.
Area hospitals say they knew the restrictions were coming and said they were OK with the changes, but they don't see this as a final solution.
Financially, they have not felt the strain of some U.S. hospitals who relied on the overtime hours of residents to fill personnel gaps.
One fear among doctors here is that residents told when to clock out will not be ready for the "real world" overtime demands of doctors and surgeons after completing their training.
The regulations are a response to studies showing young doctors who exhaust themselves working too many hours tend to make mistakes on the job.
Hospitals here adopted the rules earlier this year, anticipating the regulations.
New requirement
Until now, doctors have had few regulations for working hours because of their need for flexibility in helping patients.
"Continuity of care" was of high priority, said Dr. Eugene Mowad, interim director of medical education at Forum Health.
Now, Dr. Mowad said, residents ending their shift while still treating a patient must communicate fully and precisely with the next doctor so that a patient doesn't suffer from a shift change.
He noted that exceptions are made if the shift change would hinder the patient's care.
The regulations were issued by the Accreditation Council for Graduate Medical Education and took effect July 1.
Dr. Mowad said it had been standard practice for a resident on call to work from 8 a.m. to 8 a.m. and then continue working until 5 p.m. Now they must stop working at 8 a.m. He said the new rules took some getting used to.
There is some flexibility to the 24-hour rule. Residents can stay up to six hours finishing paperwork or finishing care to a current patient. But the doctor cannot take on a new patient.
A time for learning
Residents work long hours at hospitals, especially those who work in surgery, because they want to learn as much as they can, said Claire Jaberg, senior director of medical education and research for Humility of Mary Health Partners.
"There are so many things that you need to learn and get exposed to," he said. Residents "want to see and try procedures to be comfortable" doing them.
Forum Health has had to hire physician's assistants and nurse practitioners to cover for the shortened work hours of residents.
The medical resident program lasts three to five years and gives specialty training to medical school graduates in areas such as pediatrics, surgery, pathology, podiatry, denistry and family medicine.
Forum Health employs 110 medical residents.
St. Elizabeth Health Center employs 61, and St. Joseph Health Center employs 16. There are also 11 medical residents at UPMC Horizon in Greenville, Pa.
A concern
Dr. Mowad supports the new regulation as a way to prevent medical residents' overuse and overwork, but, he said, "There may come a time when they want to revisit this."
He said the biggest concern is the 24-hour rule.
After 24 hours, residents cannot take more patients and then they have to wait until the next day to return to work.
This limits the total amount of training and experience the doctors receive when their residency ends, Dr. Mowad said.
To adjust, Forum Health will soon begin a "night float" program that relieves residents after 12 to 16 hours of work and thus allows them to come in the next morning, Mowad said.
But for residents in surgery, for example, the limit of hours makes it harder to master complex, specialized procedures.
Nationwide, Dr. Mowad said hospitals now must rely more on the education of residents and not lean on them for common hospital procedures.