Resident Work Hours: Addendum

I know I said wouldn't post daily, but a short addendum to the Dec 3 post on Resident Work Hours, motivated by the Editorial in the NY Times today (http://www.nytimes.com/2008/12/09/opinion/09tue3.html?_r=1&ref=opinion)
The article notes that the Institute of Medicine (IOM) report expresses concern about the current 10-year old regulations may not be being enforced: "By most accounts, the current, weaker rules are widely ignored, so it will be imperative to make sure that any revisions are adhered to..." While this raises the obvious question of "how" this will be done, it also raises the issue of where this assertion, "By most accounts..." comes from. I have seen no citations, and know of no programs where these rules are violated in any regular way (of course, there may be a rare intermittent exception). The Accreditation Council for Graduate Medical Education (ACGME) monitors this very closely, and programs violating it have serious sanctions, so I am quite surprised and wonder whether this is really true.