Wednesday, May 20, 2009
Reducing Resident Work Hours Could Cost $1.6 Billion!
The IOM (Institute of Medicine) has a new report that recommends, among other changes, improved adherence to the 2003 Accreditation Council for Graduate Medical Education (ACGME) limits, naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads.
The New England Journal of Medicine (NEJM) has a story about the "Cost Implications of Reduced Work Hours and Workloads for Resident Physicians." What are these cost implications? $1.6 billion! Not million, but billion! The authors of this study conclude that "Implementing the four IOM recommendations would be costly, and their effectiveness is unknown. If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high." The reference year in this study was 2006, so imagine the implications for 2009 and beyond!
I remember when resident work hours were capped at 80 hours per week. That occurred in 2003. If you stop to think about it, 80 hours is still a lot of work! It's practically two full-time jobs! Many hospitals and universities had tremendous difficulty implementing proper changes to accommodate this new requirement. They tried different things like a "night float" system to "call-free weeks" to "take one day off this week" to "this just isn't working so don't tell anyone and continue working your 120 hours this week."
So what's going to happen? Will resident work hours get reduced from 80 hours to something even less?