How is the Department of Veterans Affairs addressing the new Accreditation Council for Graduate Medical Education intern work hour limitations? Solutions from the Association of Veterans Affairs Surgeons

Background: The Accreditation Council for Graduate Medical Education implemented new intern work-hour regulations in July 2011 that have unique implications for surgical training at Veterans Affairs (VA) medical centers. Implementation of these new regulations required profound restructuring of trainee night coverage systems at many VA medical centers. This article offers approaches and potential solutions to the Accreditation Council for Graduate Medical Education regulations used by different surgery programs throughout the country that are applicable to the VA training environment. Methods: The information contained in this article was derived from the opinion of a panel of academic surgical leaders in the VA system and responses to a survey that was sent to national VA surgical leaders. Results: The most common solution chosen by the VA centers was hiring physician extenders (37%). The most common type of extender was a nonphysician extender, that is, nurse practitioner or physician assistant (70%), followed by a surgical hospitalist (33%), and surgical resident moonlighter (24%). Other common solutions included the following: night float for residents (22%) or interns (19%), establishing early versus late shifts (19%), or establishing cross-institutional or disciplinary coverage (19%). Conclusions: The public expects the medical community to produce safe, experienced surgeons, while demanding they are well rested and directly supervised at all times. The ability to meet these expectations can be challenging.