AMA meeting: Nap time mandate for on-call residents rejected
■ Delegates support tracking studies of how resident fatigue affects patient safety, but they say medicine -- not politicians -- should devise duty-hour rules.
By Kevin B. O’Reilly — Posted Nov. 23, 2009
Houston -- A mandated five-hour nap time for medical residents on call could worsen patient safety by disrupting the continuity of care, the AMA House of Delegates said in a report adopted at its Interim Meeting.
The AMA will urge the Accreditation Council for Graduate Medical Education to reject a protected sleep period proposed by an Institute of Medicine report published in December 2008. That and other changes proposed by the IOM come with an estimated $1.5 billion price tag and would be difficult to implement, according to AMA Council on Science and Public Health recommendations the house adopted.
"There is a growing body of information exploring sleep deprivation and care and safety issues, particularly in residents, but there is a belief that it's not complete enough to support the restrictive hours that the Institute of Medicine had recommended," said AMA Board of Trustees member Edward L. Langston, MD, a Lafayette, Ind., family physician who in the past served on the ACGME board of directors.
Delegates also said the AMA should work to keep control of duty-hour decisions in the hands of the ACGME and free from the intervention of politicians, Joint Commission or Centers for Medicare & Medicaid Services.
"Addressing the rules and regulations around the training of physicians in various disciplines should reside with the profession," Dr. Langston said.
Surgeons have been especially outspoken about the effect of duty-hour rules on training.
"There really should not be further tinkering with work-hour restrictions," said AMA Trustee Peter W. Carmel, MD, a Newark, N.J., pediatric neurosurgeon, in reference committee testimony. "Our colleagues in Europe are suffering with the fact that they have such restrictions on work hours that they cannot train neurosurgeons the way they should be trained. ... They turn out neurosurgeons who cannot pass the board of the American Board of Neurological Surgery."
Medical students also backed the AMA's stance on required sleep. "We strongly oppose the five-hour nap time rule until such a time as there are clear data to suggest the benefits of that policy," said Michael Best, a regional medical student delegate who spoke on behalf of the Medical Student Section.
The AMA will continue to study the evidence on the effect of work-hour restrictions on physician training and patient care. The ACGME is reviewing its regulations and could propose new rules in February 2010.