CHAPEL HILL, N.C. — Hollywood and television shows portray doctors in hospitals as overworked, tired and temperamental. Real doctors will admit that fiction is not too far from reality.

For some patients, it may be comforting to know their doctors are working around the clock for their sake.

"Many people, and you see this often, put the patient care ahead of their own well being," said Dr. Brendan Campbell, a surgeon at UNC Hospitals.

But that may not be good for the patient at all.

""Errors are more likely to occur when people are tired and overworked," he said.

Educational hospitals across the country face losing their accreditation if they do not address the problem of physician fatigue.

Changes mandated last summer include limiting the work week to 80 hours. If a physician is on call for 24 hours, the shift must be followed by 12 hours off and physicians must have at least 24 hours away from work every week.

The issue is so serious that Johns Hopkins' residency program regained full accreditation last month after violating the mandate.

Now, Duke Medical Center and University of North Carolina Hospitals are working together to find the best way to make the new requirements work.

Making the changes work in a hospital setting requires training and careful monitoring. It may also require more staff to pick up the slack when a resident physician hits their hourly limit.

"So in order to develop a work environment that gives quality education as well as quality patient care, the hospital has to spend money and it's mainly on personnel," said Dr. Robert Cefalo, UNC assistant dean of graduate medical education.

Campbell is concerned the new rules may be too rigid at the times when a patient may need their physician most. If the wrinkles can be worked out, he said he is all for it.

"I think, by and large, the changes have, you know, improved the quality of our lives and the quality of patient care," Campbell said.

UNC Hospitals and Duke Medical Center are using a $1 million grant to develop a model program to make these changes work within their systems. It will be freely offered to the 13 graduate medical education programs in the state in the form of educational materials and workshops.