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Invited Commentary
April 22, 2013

Resident Workload—Let's Treat the Disease, Not Just the SymptomComment on “Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff”

Author Affiliations

Author Affiliations: Division of Pulmonary and Critical Care, Christus St Vincent Regional Medical Center, Santa Fe, New Mexico (Dr Goitein); and Department of Medicine, Washington University School of Medicine, St Louis, Missouri (Dr Ludmerer).

JAMA Intern Med. 2013;173(8):655-656. doi:10.1001/jamainternmed.2013.740

Work compression is doing the same amount of work in fewer hours. The term is often used to describe an effect of the restriction of residents' work hours by the Accreditation Council for Graduate Medical Education (ACGME). But before work hour limitations were implemented in 2003, residents were already experiencing work compression. From 1990 to 2010, annual admissions to major teaching hospitals increased by 46% (Katherine Brandenburg, Association of American Medical Colleges, written communication, December 11, 2012), while first-year residency positions, limited by restrictions in Graduate Medical Education funding, grew only 13%.1 During the same period, length of stay fell by almost one-third, and intensity of care per admission greatly increased.2 In short, by the time ACGME restrictions were implemented, residents were already doing much more, in less time and for more and sicker patients, than were previous generations of house staff.

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