and 20 percent had exceeded 95 hours per week, while 60 percent of surgical residents had exceeded 95 hours per week (Kennedy, 1998). Despite increased fines and stepped-up enforcement efforts, some residency programs in New York continue to violate daily and weekly work hour limitations (Committee of Interns and Residents, 2002b).
All residency programs in the United States undergo periodic accreditation reviews by the ACGME. Although none have lost their accreditation solely for overworking residents (Kwan and Levy, 2002), 20 percent of the residency programs reviewed in 1999 were cited for noncompliance with work hour standards (Kwan and Levy, 2002). In 2000, only 8 percent of the programs reviewed that year were cited (Lamberg, 2002).
During the past year, increasing attention has been paid to hours worked by resident physicians. The ACGME has recommended that all residency programs limit resident work hours to 80 hours/week and have a maximum shift length of 24 hours (although a resident could be required to put in an additional 6 hours for transfer of patient care responsibilities, educational debriefing, didactic activities, and seeing patients in a post-call continuity clinic), and that night call be limited to every third night. Recommendations from the American Medical Association (AMA) and the AAMC are quite similar, and stress a voluntary approach (AMA, 2002; AAMC, 2002). A petition submitted in spring 2002 to the Occupational Health and Safety Administration (OSHA) by Public Citizen and the American Medical Student Association called for federal regulation, civil penalties, and public disclosure of violating hospitals (Gurjala et al., 2001). OSHA denied the petition on October 10, 2002, citing the voluntary standards being adopted by the ACGME (Public Citizen, 2002).
As discussed earlier, legislation to amend title XVIII of the Social Security Act (Medicare Act) was introduced in both houses of the U.S. Congress during the 107th session. The Patient and Physician Safety Act of 20017 would have required any hospital receiving Medicare funding to limit the hours worked by postgraduate trainees to no more than 80 hours per week and 24 hours per shift. H.R. 3236 was introduced on November 6, 2001, and referred from the House Energy and Commerce Committee to the House Subcommittee on Health on March 5, 2002.8 The Senate version of the bill (S. 2614) was introduced June 12, 2002, and immediately referred to the Senate Committee on Finance.9 No further action was taken.
In June 2001, legislation was introduced and passed by the New Jersey State Assembly limiting the work hours of resident physicians in that state