American College of Physicians: Internal Medicine — Doctors for Adults ®

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Regents address resident hours and liability reform

From the March ACP-ASIM Observer, copyright 2003 by the American College of Physicians-American Society of Internal Medicine.

By Jason van Steenburgh

At its January meeting, the Board of Regents approved policy papers on limiting resident work hours and reforming medical liability insurance. The Regents also gave their approval to reorganize a subspecialty council and form a volunteerism subcommittee within the College.

  • Resident work hours. The Regents adopted a new policy paper that calls on program directors, not state or federal regulators, to limit resident work hours. The College believes that the Accreditation Council for Graduate Medical Education should continue to monitor work hours and that its system should be strengthened to improve compliance.

    The paper says residents' total duty hours, including moonlighting, should not exceed 80 hours per week when averaged over four weeks. In addition, residents should take call no more than one night in three, the paper says, and they should have off at least one 24-hour period per week.

    The College also recommends that programs give residents at least 10 hours of rest between duty periods. Programs should also limit continuous duty time to 24 hours, with six additional hours for transfer of care, patient follow-up and education. Residents should not accept new patients after being on duty 24 hours.

    The paper also makes recommendations about alleviating residents' financial hardships.

  • Medical liability insurance. The Regents approved a policy paper calling for legislators to reform the medical liability insurance system. The paper notes that excessive jury awards have contributed to rising insurance premiums and caused some insurers to stop offering medical liability policies. When physicians cannot obtain coverage, access to care is threatened.

    To remedy the problem, the paper recommends federal legislation to limit awards in medical malpractice litigation. Specifically, the paper calls for a $250,000 cap on punitive damages and a $250,000 cap on noneconomic damages. For cases in which a physician provided immediate, life-saving care, it recommends a $50,000 cap. (The College opposes limits on economic damages)

    The paper states that capping noneconomic damages is the most effective way to stabilize premiums and should therefore be the centerpiece of any tort reform proposal.

    The College also favors a three-year statute of limitation on claims and a sliding scale for attorneys' fees.

  • Subspecialties. In a move to streamline the Council of Subspecialty Societies (CSS), the College revised the inclusion criteria for the Council to include all organizations that have an accrediting board or certificate of added competence recognized by the American Board of Internal Medicine. The Regents also voted to disband the Council of Medical Societies (CMS), though it made plans to collaborate with CMS organizations that won't be part of the CSS.

  • Volunteerism. Finally, the Regents approved converting the Membership Committee's Volunteerism Work Group to a new subcommittee. The subcommittee will give College members information on volunteer opportunities in this country and abroad. It will also identify barriers to volunteerism and ways to overcome them, and encourage cooperation between volunteer organizations and the College.

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