We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Attending Surgeon Work Hour Restrictions

Neil H. Hyman, MD; Robert A. Kozol, MD; Orlando C. Kirton, MD; David L. Berger, MD
Arch Surg. 2008;143(5):443. doi:10.1001/archsurg.143.5.443.
Text Size: A A A
Published online


At the annual meeting of the New England Surgical Society in Burlington, Vermont, a panel convened to debate the implications of attending surgeon work hour restrictions, presenting experience with work hour restrictions and then presenting arguments for and against their use. The following is a brief Commentary summarizing this discussion.

In the United States, the 2000 Institute of Medicine report, To Err Is Human: Building a Safer Health System, centered the concept of medical errors firmly in the minds of politicians, third-party payers, the national media, and patients. The concept of fatigue causing physicians to err was a central force.1 Although resident training hours have been restricted by the Accreditation Council for Graduate Medical Education since 2003, there is no legislative, board, or American College of Surgeons initiative addressing attending surgeon work hours. In 1998, the European working time directive legislated work hour restrictions for physicians, limiting weekly work hours “on average” to 48 hours, placed limits on night coverage, and delineated mandatory rest periods. Attending surgeon work hour restrictions in Europe resulted in increased specialization, decreased availability of broad-based surgical capabilities, increased difficulty in securing evening and emergency coverage, increased difficulty acquiring critical care and trauma experience, and decreased availability of comprehensive surgical care. Surprisingly, the European working time directive does not apply to overtime and, in fact, 113 000 physicians worked more than 50 million hours of overtime in Germany in 2003, corroborating a notion that European physicians may not be abiding by the restrictions.2

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

4 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles