Residencies brace for disruptions with new work hours. (July 1 Implementation Date).

Most residency programs will be able to comply with the new work hours that go into effect in July, but they'll have to make some adjustments.

Dr. Ingrid Philibert, director of field activities with the Accreditation Council for Graduate Medical Education in Chicago, admits that some residencies may have an easier time of it than others, depending on the size and wealth of the program.

Primary care residencies in particular are worried about a disruption in continuity of care because of the shorter hours. These programs "have let us know that this will be an issue for them," Dr. Philibert told this newspaper.

Concerns also remain that residents will adopt a shift mentality and "go home when the bell rings." Residency programs are wondering if this will educate residents to respond effectively to patients, she said.

The new ACGME standards limit duty hours to 80 per week, with a minimum of 10 hours off between shifts. At least one 24-hour day each week should be free of patient care duties. Residents must not be on call more often than every third night.

Continuous time on duty is limited to 24 hours, although residents may take 4-6 additional hours beyond that limit for optimal education and patient care.

Family medicine, pediatrics, and surgical specialties join other specialties that have had such limitations in place for years. Internal medicine, for example, imposed an 80-hour workweek in 1989, followed by dermatology, preventive medicine, and ophthalmology.