Given the relative dearth of news on Sunday, I've decided to pick an issue each Sunday and share my thoughts. These past 2 weeks the key issue comes from the ACGME and the AMA. First the ACGME published their proposed new guidelines on resident work hours Click on ' ACGME Approves New Common Requirements for Resident Duty Hours'. Later in the week the AMA endorsed those limits AMA endorses limit on residents' hours . Let's revisit the proposed new requirements and try to understand their impact.

All these requirements work on 4 week averages.

• 80 hour limit per week


• 1 full day off each week


• No more than 24 hours on call with up to 6 additional hours to insure patient care continuity


• Call no more frequent than every 3rd night


• Complex moonlighting recommendations

Now let's assume an every 4th day cycle. We have 7 call days in our 4 weeks. Thus, we have 210 hours for those 14 days (7 on call/post call combos) - with 110 hours remaining on the remaining 10 days (assuming 4 full days off). This allows for 11 hour days. In our program, weekend days often take no more than 5 -6 hours.

Putting this into perspective, the residents will have to become more time efficient and more willing to give tasks to the on call team (because they will have to leave at a reasonable time). This requires a culture change amongst many residents. Residents have their own macho culture of taking care of everything prior to leaving. We will now have to force this culture change.

So these rules will put some pressure on residents. Likewise attendings will have pressure to reconsider postcall rounds. At our institution many of us have learned that post call rounds are often "survival rounds". We come in at 7:00 a.m. post call to make certain that significant patient care issues have attending input very early in the day. I've learned that post call days cannot involve extensive teaching (unless it happens to follow a very light call day). Attendings will have to make adjustments for the residents.

Are these rules good or necessary? I'm not certain that these are the right limits. As I referenced on Tuesday, Sleep Won May Come at a Price. Sometimes patient care does require longer hours. Most residents know this and respond appropriately. By strictly limiting hours to 80, sometimes patient care could suffer. Residency training now enters a major transition. Residents and attendings will have to work hard together to make these limits work both for education and patient care.