Medical Resident Maximum Hour Regulations: Overcoming Institutional Resistance For Real Reform

Braham Boyce Ketcham, University of Iowa

Abstract

This paper addresses the problem of medical resident hours restrictions. Self-regulation by the graduate medical education community pushed excesses underground, as institutional resistance has led to underreporting of hours to meet the official limits. But sleepy and overworked residents pose risks to themselves and their patients, making reform imperative. This paper provides an overview of previous attempts at regulation, addresses the weaknesses of current proposals, and suggests an alternative that respects professional autonomy and doesn’t interfere with the educational purpose of residency programs. This proposal is modeled on previous successful hospital regulations that reward voluntary compliance instead of punishing violations.