A study by medical researchers at the University of California at Los Angeles and the RAND Corporation has found that recent recommendations intended to reduce medical residents’ working hours could cost the nation’s teaching hospitals about $1.6-billion annually — without necessarily improving patient safety.
A report on the study, published in the May 21 issue of The New England Journal of Medicine, concludes that hospitals that have grown accustomed to assigning residents to shifts of more than 80 hours a week would have to spend millions of dollars hiring replacement workers like nurse practitioners and physician assistants.
“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 the report’s lead author, Teryl K. Nuckols, an internist at the David Geffen School of Medicine at UCLA and a researcher at RAND, a nonprofit research group. “There is no obvious way to pay for these changes, so that’s one major issue that must be addressed.”
Residents, after graduating from medical school, typically spend three to seven years training under the supervision of more-experienced doctors. Marathon work schedules have long been a rite of passage for new doctors, who gain experience in their specialties by treating large numbers of patients.
But those schedules have come under increasing scrutiny in recent years. In 2003 the Accreditation Council for Graduate Medical Education told hospitals to limit residents’ work weeks to 80 hours, but those limits were widely ignored. The Institute of Medicine released a report in December recommending stricter adherence to those guidelines. It suggested scheduling residents for no more than 16 hours at a stretch, with more time off for sleep between shifts. The goals were to create a more humane work environment for the doctors in training, and to reduce the chance that sleep-deprived residents would make medical mistakes.
But the new report echoes recent questions by some medical educators about whether any reduction in fatigue-induced errors might be offset by mistakes residents make because they are having to hand patients off more frequently as a result of their restricted work shifts. —Katherine Mangan