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Excerpt
The ACGME does not receive authority from the Department of Education or any branch of the federal government. Instead, the ACGME expresses the profession's efforts to regulate itself. It is composed of volunteer expert physicians, residents, and the public. A federal member sits as an important liaison between the profession and the government, but is without a vote. The ACGME is configured as a free-standing 501(c)(3) corporation whose mission is “to improve the quality of health care in the United States by ensuring and improving the quality of graduate medical education experiences for physicians in training.”
I offer the statements above as more than just a technical correction of Dr. Srinivas' and Mr. Rising's perceptions. My goal is to emphasize that at the heart of professionalism is the capacity of the profession to regulate itself. Their proposal to look to the federal government to ensure that these programs provide good patient care is an abdication of professionalism. My concerns about the frequency with which the ACGME detects work-hours violations arise because our behaviors and professional values are misaligned. It is our professional obligation as a community to fix the problem, not throw up our hands and turn it over to others.
Dr. Srinivas and Mr. Rising state that the ACGME can never balance the two roles of improving education and improving patient care. They would parse out the two functions. Can they be so parsed? I would argue that in the case of medicine they cannot be. The elements that go into good education are identical to the elements that go into good patient care. Residents learn by doing—if the doing is flawed the learning is also compromised. The quality of each is dependent on the other. Good learning requires good patient care.
They cite the New York State regulations as effective and as “an excellent model of reform [that] could be applied on a nationwide scale.” Yet when the ACGME reviews New York's residency programs, the peer experts doing the review regularly detect violations of the program requirements relevant to residents' work hours. We at the ACGME do not think the New York model is effective. Further, it applies rules independent of context. Our profession is rich with context, context that illuminates the correct steps “in this particular case.” To ignore context and seek a simplistic rule-based approach will compromise patient care. It is a heavy obligation of the profession to improve both education and patient care and to do so fully informed by context. When the profession detects violations in residents' work hours it must act. The solution is in our hands and can't be abdicated.
