In addition, although the ACGME has defined time off as a period free from all residency training requirements, including clinical, administrative and educational activities, there is no clear way to ascertain whether trainees are truly using these free periods to rest or are engaged in other professional activities, such as moonlighting.
New models have been proposed and implemented to comply with work-hour restrictions, and the need to meet the new regulations has steered residency programs to explore a variety of creative approaches. These include a day-float or night-float system, recruiting physician extenders, increasing cross-coverage of patients, eliminating or streamlining services, better using information technology, and requests to the residency review committees to increase the resident complement.12 Some residents have been pulled from clinical sites to cover patient care responsibilities, or senior residents have had been asked to pick up slack for junior residents. Also, attending physicians have often needed to fill in the gaps. The selection of different models has been based on local factors, availability of resources, and the nature of the clinical service, said Dr. Sachdeva. But regardless of the model that is selected, unless the entire educational program is restructured with different educational approaches and interventions, the residents may not receive the requisite education and training.12, 14
The financial costs engendered by these restrictions are significant and, for the most part, not compensated. These costs include the necessity of hiring additional physician extenders that many institutions cannot afford.