Goal is to improve patient safety and health outcomes, but who is going to pay?
Pathologists are aware of the ongoing debate about the overwork of medical residents, who traditionally worked 100 or more hours per week. Medical experts regularly point out how overworking medical residents may result in fatigue-related adverse events that negatively affect patient safety. These adverse events cost teaching hospitals money in additional care and/or malpractice claims. Now comes a new report published in the New England Journal of Medicine (NEJM) which determined that it remains more profitable to continue this practice than to hire extra help.
The study, Cost Implications of Reduced Work Hours and Workloads for Resident Physicians, was conducted by researchers from UCLA and the RAND Corp, a nonprofit research facility in Los Angeles. The study was initiated in response to recommendations from the Institute of Medicine (IOM) to limit medical resident work hours.
For many decades, graduate medical education programs regularly worked residents more than 100 hours weekly during their three- to seven-year training period. In 2003 the Accreditation Council for Graduate Medical Education adopted guidelines that limited the resident work week to 80 hours, with no more than 30 consecutive hours per shift.
The IOM recommends maintaining the 80-hour resident workweek, so long as at least five hours of uninterrupted sleep are provided between 16-hour shifts. The new IOM guidelines also call for reducing resident workloads and increasing time off to one day per week and five days per month.
According to the NEJM report, these recommendations could cost teaching hospitals $1.6 billion extra annually in labor costs. The IOM estimated the additional cost to comply with IOM recommendations for teaching hospitals would be in the range of $1.7 billion.
“Adopting new restrictions on the work hours of physicians in training would impose a substantial new cost on the nation’s 8,500 physician training programs,” said lead author Dr. Teryl K. Nuckols, RAND researcher and internist at the David Geffen School of Medicine at UCLA. “There is no obvious way to pay for these changes, so that’s one major issue that must be addressed.”
“Residency programs already have picked much of the low-hanging fruit by reducing the non-educational duties placed on residents,” Nuckols continued. “Further changes will require that hospitals hire professionals with high levels of training, such as nurse practitioners and physicians, and that will be expensive.”
The IOM report addressed the impact that reducing resident working hours would have on the healthcare system. The study authors estimated that, as shorter resident work weeks are implemented, it would require an additional 7,600 specialty residents per year nationally to provide the necessary coverage.
The IOM recommendations and the NEJM’s published study highlight the dilemma for healthcare policymakers. Taking steps to improve patient safety and patient outcomes requires additional spending. As most pathologists and laboratory professionals know, budgets at medical schools are already inadequate to meet existing needs.
With an estimated cost of $1.6 billion per year to comply with reducing the work week of medical residents, there will be slow progress on implementing these recommendations uniformly in all medical schools across the nation.– P. Kirk