In December 2008, the Institute of Medicine published new recommendations regarding duty hours and supervision of residents' training in the United States. These recommendations evoked immediate concerns from program directors and leadership in all surgical and medical disciplines, including pediatrics. To address these concerns, the Accreditation Council for Graduate Medical Education convened a Duty Hours Congress in Chicago, Illinois, on June 11 and 12, 2009. This report summarizes the opinions and testimony of the organizations (American Academy of Pediatrics, Association of Pediatric Program Directors, and Council of Pediatric Specialties) that were invited to represent pediatrics at the Duty Hours Congress. The American Academy of Pediatrics, the Association of Pediatric Program Directors, and the Council of Pediatric Specialties supported the basic principles of the Institute of Medicine report regarding patient safety, resident supervision, resident safety, and the importance of effective “hand-offs”; however, the organizations opposed additional reductions in resident duty hours given the potential unintended adverse effects on the competency of trainees, the costs of graduate medical education, and the future pediatric workforce. These organizations agreed that additional changes in graduate medical education must be data driven and consider residents within the broader system of health care. The costs and benefits must be carefully analyzed before implementing the Institute of Medicine recommendations.
The Response of the APPD, CoPS and AAP to the Institute of Medicine Report on Resident Duty Hours
California Health Maintenance Organizations (HMO's) Establish Time Standards: For the first time, physicians in HMO's in California are being required to see a patient within ten days if they are generalists, and two weeks if specialists. According to an article in The New York Times (Archibold RC, January 19, 2010), physicians must find ways (with their staff or partners) to return a call within 30 minutes and be available 24 hours a day. Urgent needs must be accommodated within 48 hours. While this may certainly reduce the frequent long waits for patients to be seen in these California HMO's, the risk is that premium costs may go up as practices hire more physicians or incur other staff costs to meet the time requirements. The situation could be even worse if more patients are given access on a national basis to HMO health insurance options. As to what happens if a patient reports an HMO for not complying with time standards, there would apparently be a possible audit and fines that could ensue. Whether other states will follow with similar results awaits the lessons to be learned from implementation of this new California state law.
Noted by JFL, MD
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Susan Guralnick, Jerry Rushton, James F. Bale, Victoria Norwood, Franklin Trimm, Daniel Schumacher; The Response of the APPD, CoPS and AAP to the Institute of Medicine Report on Resident Duty Hours. Pediatrics April 2010; 125 (4): 786–790. 10.1542/peds.2009-2149
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