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ACGME Revises Cap on Resident Work Hours

by Richard Quinn •

The first formal recommendations came in 1988, when a task force said residents should spend one day in seven away from a hospital and be on call no more than every third night. The next year, the now standard 80-hour workweek, averaged over four weeks, was put in place for internal medicine. Over the next few years, five more specialties added a weekly work-hour limit.

In 2001, ACGME created the Working Group on Resident Duty Hours and the Learning Environment. In large part, the report was inspired by the 1999 Institute of Medicine report, “To Err is Human,” which found that between 44,000 and 98,000 people die annually in hospitals due to preventable medical errors.

In 2003, the 80-hour weekly limit became standard for all specialties.

Fast forward to 2008, when ACGME was slated to “explore refinements” to its rules. The organization waited until 2010 for a report from Institute of Medicine and the Agency for Healthcare Research and Quality that examined resident hours.

Those standards were updated in 2010, and ACGME’s 2011 revisions were based in part on the updated version.

Timeline of Resident Work Hours

Early 1900s: Medical residents generally reside in a hospital; hence the term “resident.” House staff work every day and every other night.

Mid-1900s: Residents and interns are on call for 36 hours starting every other night, totaling more than 100 hours per week.

1975: Residents in New York City go on strike, calling for fewer hours. They return to work after hospitals agree to reduce on-call frequency from every other night to every third night.

1981: ACGME is formed.

1987: After Libby Zion’s case in 1984, New York State recommends an 80-hour limit on weekly resident duty hours, with no more than 24 consecutive hours on duty.

1990: ACGME sets an 80-hour workweek in four specialties (internal medicine, dermatology, ophthalmology, and preventive medicine) and limits on-call duties to every third night, with at least one 24-hour period off every seven days.

2001: Federal legislation is proposed to limit resident work hours.

2003: ACGME announces duty-hour requirements for all specialties, including an 80-hour workweek, one day off in seven, and a maximum shift length of 24 hours.

2011: ACGME restricts interns to 16-hour shifts.

2017: ACGME raises cap on resident duty hours to 80-hour weeks, with shifts of no longer than 24 hours, and up to an additional four hours for handoffs.

Source: ACGME