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The ACGME currently has work-hour requirements that apply to all specialties. Residents must have at least one full day out of seven free of activities involved in patient care and must not be assigned on-call duty more often than every third night, both averaged over a four-week period. Otherwise, the standards vary widely among specialties. Five specialties (allergy and immunology, dermatology, internal medicine, ophthalmology, and preventive medicine) have a weekly limit of 80 hours of work, averaged over a four-week period. Emergency medicine limits weekly hours to 72, of which only 60 hours may be spent in patient care. The requirements for general surgery give the program director the responsibility of ensuring the assignment of appropriate in-hospital duty hours.
They claim, in part, that graduate education in surgery requires a commitment to continuity of patient care. This continuity of care must take precedence without regard to the time of day, day of the week, number of hours already worked, or on-call schedules. After a site visit in July 2001, the ACGME withdrew the accreditation of the general-surgery residency program at Yale New Haven Medical Center, effective June 30, 2003, because of excessive work hours. For some rotations, residents routinely worked more than 100 hours per week; for others, they were on call every other night or did not regularly have one day off out of every seven, according to Dr. Peter Herbert, the senior vice-president for medical affairs at the medical center. In response, Yale has made extensive changes, including hiring physician's assistants to work on many surgical teams.
The ACGME conducted a follow-up review in August 2002 and will decide whether to restore Yale's accreditation. Until recently, New York State, which has 115 teaching hospitals and about 15, 000 residents, has not vigorously enforced its work-hour limits. In 1998, the New York Department of Health conducted simultaneous, unannounced surveys at 12 teaching hospitals. 9 After calculating working hours for 391 residents, it found that 37 percent worked more hours than the regulatory limits allowed; 77 percent of surgical residents in New York City and 32 percent of surgical residents in other parts of the state worked in excess of 95 hours per week. Four hospitals were fined up to $ 20, 000 each. The New York Department of Health conducted intensive educational programs about the work-hour requirements.
The state increased the maximal fines to $ 6, 000 per violation for a first offense, $ 25, 000 for a second offense, and $ 50, 000 for a third offense and funded a surveillance program. 31 Of the 82 teaching hospitals inspected between November 2001 and June 2002, 54 were cited for violations. One was fined for recurring violations. The enhanced scrutiny in New York State has captured everyone's attention, but achieving full compliance has been a rocky road for many hospitals, according to Tim Johnson, the director of health finance and physician policy for the Greater New York Hospital Association. One reason is that compliance is an all-or-nothing proposition; 92 or 95 percent compliance is technically noncompliance. A hospital does not get credit for being mostly in compliance. Many hospitals have responded by hiring more physician's assistants and other professionals.
The number of registered physician's assistants in New York increased by 62 percent over a five-year period from 3893 in 1997 to 6294 in 2002. The limits on hours have met with skepticism as well as enthusiasm.
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Research essay sample on Hours Per Week Department Of Health
