Re: The True Cost of Resident Work-Hour Restrictions
From: Joe (forcep@intercom.net)
Thu May 21 15:41:07 2009
Duh? Joe C
GIN11153@aol.com wrote:
> Elyas Bakhtiari, for HealthLeaders Media, May 21, 2009
>
> http://www.healthleadersmedia.com/content/233456/topic/WS_HLM2_PHY/The-True-Cost-of-Resident-WorkHour-Restrictions.html
>
> Work restrictions intended to limit residents' fatigue and stress, and
> as a result reduce medical errors, have associated labor costs of nearly
> $1.6 billion per year
> <http://www.healthleadersmedia.com/content/233445/topic/WS_HLM2_PHY/Study-Trimming-Residents-Hours-Would-Cost-Teaching-Hospitals-16-billion-Annually.html>,
> according to a new study in the New England Journal of Medicine
> <http://content.nejm.org/cgi/content/short/360/21/2202>. That figure
> includes costs associated with handing off excess work from resting
> residents to substitute providers.
>
> The researchers based their assumptions on Institute of Medicine
> recommendations to improve adherence to the ACGME's 80-hour work week,
> encourage naps during extended shifts, and limit shifts without naps to
> 16 hours. They also tried to measure costs associated with preventable
> adverse events and the total societal costs of the restrictions.
>
> Their ultimate conclusion was that the effectiveness of the IOM's
> recommendations 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," they wrote.
>
> But are those the only costs tied to work restrictions?
>
> It has taken me a while to wrap my head around the controversy of the
> 80-hour resident workweek. I confess, in my mostly Monday-Friday, mostly
> 40-50-hour work world, 80 hours seems like an admirable and exhausting
> commitment. When I first began learning about resident work restrictions
> I assumed that it was a no-brainer. Of course residents are going to
> become fatigued and make more errors if they're working 120 hours a week
> on little sleep.
>
> I still think resident exhaustion is worth addressing, but some recent
> conversations with physicians and administrators have opened my eyes to
> some of the long-term negative impacts of the 80-hour workweek.
>
> The work restrictions seem to be gradually and not-so-subtly changing
> physician culture. Physicians have traditionally been known for basing
> the amount of hours they work on the amount of work that needs to be
> done. Many doctors take pride in not leaving the hospital until all
> their patients are cared for.
>
> As residents get accustomed to limited shift work in their training,
> however, they are increasingly looking for similar scheduling
> arrangements in their post-residency careers. Physicians, particularly
> those early in their careers, are shying away from private practice in
> favor of employment arrangements with set schedules. They are favoring
> specialties like dermatology that are known for both high compensation
> and a controllable lifestyle.
>
> "One of my concerns is that a lot of the doctors in training are now
> going to this have mindset that I only have to work so many hours and
> I'm gone, it's somebody else's problem," says John Jeter, MD, CEO of
> Hays Medical Center, a 153-staffed-bed community hospital in Kansas.
> "That's not how it works. You can't abandon patients and partners."
>
> This is particularly troubling at a time when severe physician shortages
> are being projected. There are also concerns that residents working
> fewer hours aren't getting the training they need and the length of
> residencies may have to be extended, slowing the development of
> much-needed new doctors, Jeter says.
>
> So what's the solution? Work residents to exhaustion and risk
> preventable errors? Continue with the restrictions and lose physician
> productivity?
>
> "There has got to be some in-between where there are still many
> opportunities to learn what needs to be learned without it being an
> unhealthy environment," says Jeter. "I'm not sure we've found the balance."
>
> ------------------------------------------------------------------------
> Note: You can sign up to receive HealthLeaders Media PhysicianLeaders
> ------------------------------------------------------------------------
> <http://www.healthleadersmedia.com/customer/enewsletter-subscribe/item/3987/PhysicianLeadersENewsletter.html>,
> ------------------------------------------------------------------------
> a free weekly e-newsletter that features the top physician business
> headlines of the week from leading news sources.
> ------------------------------------------------------------------------
> Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be
> ------------------------------------------------------------------------
> reached at ebakhtiari@healthleadersmedia.com
> ------------------------------------------------------------------------
> <mailto:ebakhtiari@healthleadersmedia.com>.
>
> ------------------------------------------------------------------------
> Huge savings on HDTVs from Dell.com!
> ------------------------------------------------------------------------
> <http://pr.atwola.com/promoclk/100126575x1221836042x1201399880/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B215073686%3B37034322%3Bb>
> ------------------------------------------------------------------------
|
|
