Limitations on residents' working hours at New York teaching hospitals: a status report

Teaching hospitals in New York have been subject to regulations that limit the working hours of residency trainees since July 1989. Following a period of enhanced survey activity by the State Department of Health in the late 1990s, the state awarded a contract to a third-party organization to conduct annual audits of the state's teaching hospitals to assess compliance with the regulations. As of October 2002, preliminary results indicate that 75 of the 118 teaching hospitals in the state (63.6%) were found to be out of compliance with some component of the regulations. The most common citations for noncompliance were (1) working in excess of 24 consecutive hours (45%), and (2) working in excess of 80 hours per week, averaged over four weeks (28%). For New York teaching hospitals, the key factors identified as posing significant challenges to achieving full compliance with the regulations included (1) assuming responsibility for the work schedules of residents; (2) scheduling and monitoring difficulties; (3) the education efforts associated with the regulations; (4) the documentation requirements; (5) variations in learning abilities among the residents; and (6) mistaking verbal compliance for actual compliance. As the state begins a new round of surveys, it will be expecting better compliance efforts, and New York teaching hospitals are committed to this difficult but worthy goal.