Home > Medical/Health Commentary > Intern work-hour limits and licensure

Intern work-hour limits and licensure

Arguably the biggest highlight of the ACGME’s proposed new resident work-hour policy (discussed earlier here) is the limitation of intern work-hours to 16, reduced from the current 24+4.  Dr. Vineet Arora at FutureDocs points out that this proposed new regulation fundamentally changes the “contract” of post-graduate medical education, in which things are supposed to pick up, in terms of quality of life, after the PGY-1 year.

This got me thinking about licensure.  These new rules seem predicated at least in part on the assumption that newly-minted doctors will complete at least three years of post-graduate training, thereby becoming “board-eligible” in the specialty in which they trained.  Medical licensure, at least in most states, doesn’t make that assumption.

According to the Federation of State Medical Boards, only 17 US states and territories require more than one year of post-graduate training; the remainder require just completion of intern year before allowing graduates to practice medicine independently and without supervision (all this applies to graduates of Canadian/US medical schools only).

I haven’t seen any claims about how the new rules would affect the educational experience and practice-ready status of internship graduates, but I don’t think it’s too much of a stretch to think that there would be some… in which direction, I wouldn’t know.  I also can’t find any numbers on how many physicians stick out a shingle and start seeing patients after only 1 year of postgraduate training, but I can’t imagine it being too high, especially since board-certification seems more and more to be a pre-requisite for hospital jobs/privileges, and employment with larger medical groups.

What this means is that the presumably small number of physicians who go on to practice with only one year of post-graduate education under their belts might not have as much experience as they would have under the current rules.  This probably won’t be much of a big deal in the grand scheme of things.  It does, however, prompt me to ask whether the ACGME should consider its policies in light of the fact that graduating interns are allowed to practice independently in most states.  If not, maybe (and I must stress “maybe”) it’s time for state medical boards to start insisting on residency completion before granting licenses to practice.


In other news, Cavalcade of Risk has been posted this week.  It includes my earlier discussion of the new ACGME proposed rules, subject to the admonition, conceded and well taken, that the post might be a bit too tangential to the topic of risk.

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