Stephen J.LurieMD, PhD, Senior Editor
In Reply: Dr Potee points out that a concern in New York State's regulation of resident duty hours has been prior lax enforcement. Any approach, whether involving accreditation or regulation, is only as good as the enforcement processes that support it. New York's regulation and the ACGME's ongoing efforts through the accreditation process are different approaches to attain the same goal: limiting resident hours. Both use sanctions, and it can be debated whether use of fines (usually a small fraction of the economic worth of residents to a given institution), or loss of accreditation (and thus the ability to train residents), is the more effective approach. Ultimately, for both, success depends on teaching institutions' willingness to limit duty hours, because their academic and managerial leaders shape the environment in which residents work and learn.
Philibert I, Friedmann P, Williams WT. Limiting Residents' Work Hours. JAMA. 2002;288(23):2974. doi:10.1001/jama.288.23.2974-JLT1218-6-4