The Medical Resident Working Hours Debate: A Proposal for Private Decentralized Regulation of Graduate Medical Education

The debate over the regulation of resident working hours has been one of the most significant recent controversies in graduate medical education. A diverse array of organizations, including Congress, state governments, administrative agencies, and the Accreditation Council for Graduate Medical Education (ACGME), have had to confront this issue at some point over the past two decades. While a consensus has developed that at least some aspects of resident working conditions should be regulated in order to enhance patient safety, there remains an ongoing controversy over which organizations should implement and oversee these regulations. This Note examines and evaluates the costs and benefits of allowing certain bodies to regulate physician residency programs.

Although most scholarship has promoted regulation either by governmental entities, the ACGME, or residents themselves, none of these groups is suited to this task. This Note argues that the ideal regulatory system should involve a decentralized private sector approach, achieved by ending the ACGME monopoly over graduate medical education accreditation and allowing for multiple accrediting agencies. Switching to a private decentralized system would allow for greater experimentation, which would increase the likelihood of discovering the best way to regulate resident working conditions to enhance patient safety.