proposed, on the argument that they would then choose the best training programs. The 2002 Jung v. Association of American Medical Colleges anti-trust case sought more freedom for medical residents to negotiate working conditions. In order to obtain accreditation as doctors, American medical residents are required to enter into a contract to accept whatever residency position they are assigned; they are then matched to a job by the AAMC and told what the working conditions and pay are. The plaintiffs allege that this is an anti-competitive practice, and that the defendants artificially limit the number of resident positions available. The suit had some early success, but failed when the U.S. Congress enacted the Pension Funding Equity Act in 2004, which exempting matching programs from federal antitrust laws. Where there is a shortage of doctors, proposed solutions include reducing the costs of medical training and more extensive training for nurses, who then take over duties formerly done by doctors. Improving the working conditions of doctors might also increase recruitment and decrease burnout leading to fewer doctors leaving medicine. Regulations EU regulation Junior doctors in the European Union fall under the European Working Time Directive, which specifies: 48 working hours per week (down from 56 under the old UK regulations), calculated over a period of 26 weeks. 11 hours continuous rest per day one day off each week, or two days off each fortnight 20 minutes of continuous rest every 6 hours However, junior doctors may choose to work more than 48 hours a week, or opt out of the EWTD entirely by signing a waiver with the employer. They may not be punished for not working more than the directed hours. Many trainees nonetheless feel obliged to work longer hours. The rest times are mandatory, but may be taken at another time if it cannot be taken as scheduled. American regulation The issue is politically controversial in the United States, where federal regulations did not limit the number of hours that can be assigned during a graduate medical student's medical residency. Starting in 2003, with revisions in 2011, regulations from the Accreditation Council for Graduate Medical Education capped the work-week at 80 hours. As of 2018, shifts are capped (with limited exceptions) at a maximum of 24 consecutive hours of direct patient care with an additional 4 hours for transition of care (sign out, completing notes, etc.) for first, second, and