AMA opposes mandatory naps for residents, breaks with IOM

American Medical Association
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CHIGAGO, Illinois — Entering into a contentious debate, the American Medical Association has adopted a new policy against guaranteeing sleep time for residents working overnight shifts.

Requiring naps “could have significant, unintended consequences for continuity of patient care and safety, as well as being difficult and expensive to implement and monitor,” according to recommendations issued by the AMA at a recent meeting.

That position puts the AMA, the country’s largest lobbying organization for physicians, in opposition to the Institute of Medicine. Late last year, the IOM recommended protected sleep periods and work-hour limits. It wants to cut the amount of time doctors could see patients during a 30-hour shift from 24 hours to 16 hours. In addition, it wants a required five-hour sleep period between 10 p.m. and 8 a.m.

The AMA’s resolution also said it would encourage the group that oversees residency programs, the Accredititation Council for Graduate Medical Education, not adopt the IOM’s recommendations for protected sleep hours for residents. The ACGME is currently conducting a review of residents’ work hours and has been charged with developing a response to the IOM’s recommendations by December 2010.

Seven years ago, the group capped residents’ work hours to 80 per week.

In Northeast Ohio, some institutions already require naps or limit residents’ work hours. Internal medicine residents at Cleveland’s University Hospitals and the local VA Medical Center are required to take a three- to four-hour nap during their 30-hour shifts. Summa Health System in Akron has for years experimented by limiting internal medicine residents to 16-hour shifts — and most work just 13 hours.

Proponents of limiting hours and requiring naps say that doing so helps reduce medical errors made by tired doctors. Opponents counter that shorter shifts increase the likelihood a patient will be handed off from one doctor to another, which is a clumsy and potentially dangerous way to manage patients.

A study published earlier this year in the New England Journal of Medicine found that implementing the IOM’s recommendations would cost teaching hospitals a collective $1.6 billion a year, or about $3.2 million per hospital. The researchers arrived at that dollar figure by calculating the cost of substituting other skilled laborers for residents.

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