NEWS
West Virginia University College of Law
Combating Resident Physician Burnout Through Work Hour Protections
The Accreditation Council for Graduate Medical Education ( AC- GME ) requires accredited programs to limit clinical and educational work hours to no more than 80 hours per week , averaged over a four-week period . 5 “ If a program violates the ACGME ’ s requirements , it may receive a warning or be placed on probation ,” and failure to resolve violations could result in accreditation loss . 6 Although excessive work hours contribute to negative patient outcomes and physician burnout , surprisingly few regulatory safeguards are in place to ensure accurate reporting of hours and hospital compliance with ACGME requirements . One study found that 80 % of the surveyed neurology residents worked more than 80 hours a week throughout their busiest rotations . 7 Compliance with the ACGME hour restrictions may be poor because it is unrealistic for the ACGME to properly oversee nearly 8,000 accredited medical residency programs . Therefore , it must rely on residency program administrators , who have a self-interest in avoiding violations , to report work hour compliance . 8 Also , these violations are determined solely through self-reporting methods , which can be problematic because residents are reluctant to report hour violations in fear that their programs will lose accreditation , thus hindering their likelihood of becoming licensed physicians . 6 “ In a national survey of more than 1,000 surgery residents regarding the effects of the ACGME regulations , greater than 60 % of residents indicated that they falsely reported duty hours to appear in compliance , with almost 15 % doing so on a daily or weekly basis .” 9
The work culture of resident physicians has a history rooted in unrestricted work hours . It was not until a patient ’ s death in 1984 that the Libby Zion Law was enacted in New York to limit resident work hours to 24-hour maximum shifts and 80-hour workweeks . 1
Monitoring residents ’ work hours and call schedule is vital for increasing patient safety and preventing physician burnout . Longer shifts improve continuity of care for patients by decreasing the number of patient hand-offs . 2 However , prioritizing continuity of care above all else may create major patient safety risks . For example , one study quantified the effect of fatigue on residents ’ performance , finding that “ moderate levels of fatigue produced higher levels of impairment than a prescribed level of alcohol intoxication ” of 0.10 %. 3 Perhaps this explains why another study found that residents “ make 36 % more serious medical mistakes , are nearly six times more likely to make serious diagnostic errors , and are 2.3 times more likely to be involved in a car accident after a 24-hour institutional on-call .” 4 Another study found that decreasing the 24-hour maximum on-call to a 16-hour maximum on-call “ improved resident wellness , reduced burnout , and fostered an environment where residents were less fatigued and more satisfied with their educational experience .” 4
What safeguards are available to ensure that residents can openly report violations without fear of repercussions ? One proposal is to enact federal whistleblower protections for medical workers who report work hour violations , as this could provide residents with “ an incentive to disclose working condition violations and encourage them to assume a regulatory or oversight role .” 6 To effectively provide residents with a direct , anonymous channel of communication , increased centralization of oversight may also be useful . For example , an ombudsman could allow residents to anonymously report violations while giving an impartial investigator the leeway and authority to investigate claims .
The general concept of whistleblower protection laws is not new in West Virginia . West Virginia Code § 6C-1 ( a ) provides legislative protection for public employees by forbidding any employer from “ retaliating against an employee by changing the employee ’ s compensation , terms , conditions , location , or privileges of employment ” when employees make good faith reports . One may argue that this legislative protection already encompasses many residents who work at municipally owned hospitals as “ public employees ” under the statute . The statutory whistleblower protection could also prevent retaliation via accreditation loss , which changes the conditions of residents ’ original employment that offered an ACGME accredited program .
Demanding work hours that often exceed required maximums is a nationwide issue that impacts resident physician wellness . Explicit legal protections for duty hour reporting and providing a safe platform for residents to come forward with concerns over excessive work hours can effectively combat burnout while improving the quality of care they provide patients . Protections could range anywhere from a whistleblower protection statute to the appointment of an ombudsman to provide a safe , neutral reporting system .
16 • www . wvsma . org