The Scope E-Newsletter March 2009

The Institute of Medicine (IOM) recently made recommendations to adjust resident work hours by setting the maximum number of hours a resident can work without time for sleep to 16, increasing the required number of days off, and setting stricter moonlighting restrictions. In a Hematology/Oncology Today article, William Law, Jr., MD, FACE, FACP, Clinical Professor of Medicine and Chief of Endocrinology, discussed the impacts these new requirements would have on the Graduate School of Medicine, residents and the community.

Dr. Law said smaller training programs should be given greater flexibility.

"Large programs with 20- to 30-plus residents a year have sufficient manpower to accommodate unanticipated increases in workforce demand created by resident illnesses, pregnancies and post-partum absences," he said.

"Smaller programs are more likely to lack the financial resources to hire hospitalists to do this work at 400 percent of the residents' salaries," Dr. Law said. "Since it is well established that the single most accurate determinant of where a physician ultimately practices is where he completed his residency training, such rigid limits could conceivably force such programs to close their doors, thus depriving the smaller communities of the source of many of their practicing physicians."

Dr. Law also said restrictions on moonlighting could discourage residents from training in traditionally lower-compensated medical professions because residents use moonlighting to pay off large student loans.

"The inclusion of all moonlighting hours, not just in-house institutional hours, in the 80-hour total may have the de facto effect of severely restricting their freedom to earn a living while in training, which may, in turn, further discourage residents from entering traditionally lower-compensated fields, such as family practice, general internal medicine, and pediatrics," Law said. "This is not a desirable development from a societal standpoint."

To read the article published in Hematology/Oncology Today online, visit www.hemonctoday.com/article.aspx?rid=36881.

To view the report published by IOM, visit http://www.iom.edu/CMS/3809/48553/60449.aspx.

For more information on current resident duty hours, visit the Accreditation Council for Graduate Medical Education web site at www.acgme.org.