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May 22, 2009 02:30 PM | 4
In 2008, the Institute of Medicine recommended a number of changes in medical residency programs to provide better patient care and resident training: Limit shifts without sleep to 16 hours, require five-hour naps for longer shifts, increase the number of days off, improve supervision and cut down on moonlighting.
But the recommendations—which followed on rules by a national body that governs medical training—won’t come cheap, according to a New England Journal of Medicine study published this week: If implemented fully, they will cost $1.6 billion.
The estimate, which tallies the cost of hiring replacement workers, is just slightly lower than the $1.7 billion the IOM projected the changes could cost. And if the government were to pick up the tab, it would be a large toll on the already strained Medicare system, which—contributing $8.4 billion in 2007—is the largest funder of U.S. residency programs.
Despite the hefty price tag, however, "it remains unknown whether implementing the IOM's recommendations would reduce preventable adverse events," note the study authors. In fact, argue authors of an accompanying editorial, more rigid hours could even increase errors in some areas, especially by increasing the number of times a patient is handed off between care providers who might not be as familiar with the case.
But, says Luella Toni Lewis, a geriatric specialist in Jamaica, NY and president of the Committee of Interns and Residents (CIR), which has advocated for work hour restrictions, "I'd much rather get a handover to a well-rested physician than one that's been on duty for 30 hours."
The question of improving medical resident working hours and conditions has been hotly debated since Libby Zion, an 18-year-old patient, died in a New York City teaching hospital in 1984 after being seen only by an intern and resident. New York State responded by mandating cuts in resident working hours to an average of 80 hours a week, a change that the state helped to fund.
A set of very similar changes went national in 2003 when the Accreditation Council for Graduate Medical Education (ACGME), a nonprofit agency that evaluates medical programs, mandated them. The 2008 IOM recommendations came about after a comprehensive study of the 2003 regulations, sponsored by the U.S. Agency for Healthcare Research and Quality.
But the debate may be focusing on the wrong issue by zeroing in on hours, says Bertrand Bell, a professor of medicine at Albert Einstein College of Medicine in New York City who helped craft New York State’s residency work hour rules. "Supervision is more important than the hours," he told ScientificAmerican.com in an email. He explained that although ensuring that the attending physician visits each patient their residents and interns are treating might seem like a burden, it's important—both for the patient and for the student in training.
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4 Comments
Add CommentI agree 100% with the recommendations. Even a 16 hour shift is too long.
Reply | Report Abuse | Link to thisIt does not happen because the decisions are made by the rich, who know when they get to a hospital it will be to a rich persons hospital and will not be attended to by an overworked, half-asleep zombie.
I have worked long shifts and have observed my colleagues also working long shifts, had a car accident going home after a double shift, because my reflexes were all but dead at 08:30 in the morning while everyone else was bright and full of life.
Shift work and double shifts lower productivity, result in a huge increase in errors and benefit nobody except the money people.
Just wanted to pass onto your readers an important development, which is the creation of the world's largest medical message board this week. It's free and I found it here:
Reply | Report Abuse | Link to thishttp://forums.medfriendly.com/
It should be obvious that extremely long work hours for interns and residents can be detrimental to the practice of medicine however one also has to look at the other side of the situation: once a physician gains his own practice he will still be working many more hours than is average for working individuals. He needs to get used to it!
Reply | Report Abuse | Link to thisTHE COMPALSARY HOUR RESTRICTION ALSO TAKES AWAY THE EXPERIENCE ONE GAINS ON CONTINUTY OF CARE. tO TREAT AND SEE HOW YOUR TREATMENT WORKS IS THE PART OF THE EDUCATION. sOME TIME IT TAKES MORE TIME THEN THE DUTY HOUIR ALLOWS TO KNOW THE RESULTS.
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