Excessive work hours have a significant impact on the education and well-being of residents as well on the quality of patient care. In the interest of improving working conditions for residents and fellows, the Accreditation Council on Graduate Medical Education (ACGME) has issued regulations regarding resident duty hours. The Association of American Medical Colleges (AAMC) has also published a policy statement on resident duty hours. This page contains more information on these standards, special considerations for programs in the state of New York, and details on WorkForce Software's comprehensive time and attendance solution that helps programs adhere to these guidelines.

• ACGME/AMA Regulations
• AAMC Guidelines
• New York State Regulations
• The WorkForce Software Solution
• References

ACGME/AMA

ACGME regulations are summarized below:

Definitions

Total duty hours include:

• Scheduled time providing direct patient care or supervised patient care that contributes to the ability of the resident physician to meet educational goals and objectives
• Scheduled time to participate in formal educational activities
• Scheduled time providing administrative and patient care services of limited or no educational value time needed to transfer the care of patients.

Organized educational activities are of two types:

1. Formal educational activities include scheduled educational programs such as conferences, seminars, and grand rounds
2. Patient care educational activities include individualized instruction with a more senior resident or attending physician and teaching rounds with an attending physician.

Regulations

1) Resident physician total duty hours must not exceed 80 hours per week, averaged over a two-week period

• An increase of 5-10% may be appropriate for some training programs. Requests for such an extension require the approval of the ACGME's Program Requirements Committee and Board of Directors.

2) That workdays that exceed 12 hours are defined as on-call.

3) That scheduled on-call assignments should not exceed 24 hours. Residents may remain on-duty for up to 30 hours to

• Complete the transfer of care
• Patient follow-up
• Education

• New patients
• Cross-coverage of other providers' patients
• Continuity clinic

4) That on-call be no more frequent than every third night and there be at least one consecutive 24-hour duty-free period every seven days both averaged over a two-week period.

5) That on-call from home be counted in the calculation of total duty hours and on-call frequency if the resident physician can routinely expect to get less than eight hours of sleep.

6) That there should be a duty-free interval of at least 10 hours prior to returning to duty.

7) That limits on total duty hours must not adversely impact resident physician participation in the organized educational activities of the residency program. Formal educational activities must be scheduled and available within total duty hour limits for all resident physicians for at least eight hours per week averaged over a two-week period.

8) That scheduled time providing patient care services of limited or no educational value be minimized.

AAMC

The AAMC offers the following guidelines for resident duty hours:

1) No resident should be scheduled on-duty for more than 80 hours in any week

• For clinical rotation settings, a resident should not be scheduled for more than 24 consecutive hours
• For continuous duty in high-intensity settings (emergency rooms, critical care units, etc.) residents should not be scheduled for more than 12 consecutive hours

2) Duty-free intervals between periods of on-call should be at least 8 hours

3) If moonlighting is authorized, time spent doing so should be included within total duty hours; if unauthorized, moonlighting should be prohibited

4) Residents should not have overnight on-duty call more frequently than one night in three, as averaged over a four-week period

5) Residents should have at least 24 hours free of all assigned duty every 7 days

6) On-duty time spent delivering patient care services of marginal or no educational value should be minimized

New York State Regulations

The New York State government has previously passed laws concerning resident duty hours. These stipulate that a resident must have 8 hours of rest between on-duty periods and that only a three-hour debriefing period is allowed after a 24-hour continuous duty period. These 405 rules conflict with some of the ACGME standards. After July 1, 2003 programs in New York State must conform to the more restrictive regulations, for example:

• A 10-hour rest period between on-duty calls
• A three-hour maximum debriefing period after 24 hours of continuous duty

The WorkForce Software Solution

WorkForce Software is pleased to provide a specialized version of our time and attendance solution for teaching hospitals that need to maintain accreditation from the ACGME or compliance with AAMC standards. For more information, please see the page on the Resident Duty Hours Version of our time and attendance software.

References

Accreditation Council on Graduate Medical Education (ACGME)
ACGME Resident Duty Hours FAQ
Association of American Medical Colleges (AAMC)
American College of Surgeons Statement on Residency Work Hours
American College of Physicians Paper on Resident Duty Hours