Thursday, November 5, 2009

duty hours debate: does promoting patient safety necessarily mean further reductions in duty hours?

In December of 2008, the Institute of Medicine published a report titled: Resident Duty Hours: Enhancing Sleep, Supervision and Safety. I have to admit that I have only read the Report Brief and the table of recommendations found on their website, however, it appears clear that the report suggests modification of current ACGME rules for shift length (although not theoretically reducing the overall 80 hours), and tightening of monitoring processes by the ACGME are needed.

The report was published almost a year ago, why bring it up now? One of the Staff here at the Cleveland Clinic brought the open letter from Dr. Thomas Nasca (CEO for ACGME) to my attention yesterday. I was so impressed by Dr. Nasca's thoughtful response to the report that I decided to scrap the topic planned for November and bring your attention to this document. After reading Dr. Nasca's letter, I wondered what our community was thinking about the IOM report and the ACGME response.

It would be hard to imagine that any physician group would argue against patient safety. The primacy of keeping patients' safe is one of the foundational principles of the social contract that physicians have with the public. After reading Dr. Nasca's letter, I can see that there are many contributing factors to a safe clinical environment. Sometimes these 'competing goods' are in conflict. A well rested resident is a good thing. Fewer staff hand-offs during care is also a good thing. If you haven't read Dr Nasca's letter and you teach residents, I suggest you take the time. I hope you also take the time to share your opinions on this vitally important issue.


Strong opinions were voiced by our respondents to the question: Are Academic RVU's the Answer to Making Time for Teaching? It appeared that either the respondent was strongly in favor or strongly opposed. Those in favor thought that, although not perfect, academic RVU systems provide a way to "account for and recognize" academic efforts. A few of those opposed, seemed "opposed in principle", not really articulating a rationale. However, a small number cited the problem of reducing a highly complex activity (teaching, advising, mentoring) into an artificial formula. In fact, one reader stated that "going down this "slippery slope" could be likened to "pandering to the bean counters". Whether or not Academic RVU's surface again as an option, we know that there will be strong opinions on both sides.