Workweek of Interns, Residents Is Improving : Medicine: Hours are being voluntarily limited at university hospitals, according to a UC report. But an association of doctors in training says the reforms are inadequate.

Working conditions for physicians in training at university hospitals have improved significantly through the implementation of a maximum 84-hour workweek for many physicians and a 12-hour limit on scheduled emergency room shifts, according to a new University of California report.

The state’s academic medical centers “have been working very hard on this over the last several years,” said Dr. Cornelius L. Hopper, UC vice president for health affairs. “Residents do work very long hours under stressful conditions. This needs to be alleviated to the extent that we can.”

But the voluntary reforms listed in the report were immediately challenged by the California Assn. of Interns and Residents (CAIR), which represents 2,000 physicians in training, as inadequate measures to assure quality medical care.

The report specifically applies to California’s eight medical school hospitals, which employ a minority of the state’s 8,000 resident physicians. Changes at university hospitals, however, often are influential with other hospitals, many of which are university affiliates.

The association renewed its call for legislation mandating a maximum 80-hour workweek for all physicians in training. A bill sponsored by the organization was introduced in the Legislature on Wednesday by Assemblywomen Jackie Speier (D-South San Francisco.)

The University of California has opposed similar legislation that Speier has introduced in the past. This year, UC officials attempted to persuade Speier that legislation is no longer necessary. The assemblywoman said that she was encouraged by the changes that have been made but that her bill is still important.

“She believes that the (series of bills) is one of the major reasons why progress is being made,” said Richard Steffen, Speier’s chief of staff. “The bill has been a very important motivator for change.”

“Legislation will be necessary to assure patients that all physicians in all hospitals are adequately rested and able to provide the quality care they deserve,” said Dr. Evan Ashkin, a resident at UC San Francisco and an association spokesman.

The reforms were recommended in December, 1988, by a committee organized by the University California. The committee included representatives from the state’s eight medical schools--Loma Linda, Stanford, UC Davis, UC Irvine, UCLA, UC San Diego, UC San Francisco and USC.

The reforms are in part a response to the protests of physicians in training and public fears that interns and residents are working too many hours and providing inadequate medical care.

According to the report, released this week, “virtually all” residency training programs at university hospitals have initiated changes so that in-hospital overnight duty is scheduled no more frequently than every third night. The primary exceptions are in surgery training programs. The reduced call schedules are often not in effect when residents work in non-university hospitals, such as county facilities.

“There was a concern that the medical schools were being perceived as not addressing the substantive issues that have been raised,” said Dr. Neil H. Parker, the UCLA representative on the committee that prepared the report. “In fact, there is a lot of activity going on and a lot of changes.”

At UCLA, Parker said, no more than three out of the 70 physician-training programs require in-hospital overnight duty more frequently than every third night and most require overnight duty less often.

The report said many university hospitals have shifted tasks such as secretarial services, drawing blood and transporting patients from interns and residents to ancillary personnel. These personnel are usually available 24 hours a day.

The reforms are to be fully implemented by July, 1993. Medical school officials acknowledge that there will continue to be exceptions, as a result of funding shortages, the need to provide continuing care to patients, and educational requirements.