Efforts to reduce the 100 hours or more worked by many medical residents each week will
increase costs for U.S. teaching hospitals and may hurt patient
care, doctors wrote in the New England Journal of Medicine.
Residents spend several years training in a specialty after
getting medical degrees and are used as an inexpensive source of
labor by some hospitals. A group that sets standards for residents
limited work hours to 80 per week, with a maximum 24 hours per
shift and at least one day off, starting in July 2003.
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Hospitals may require residents to care for more patients
during shifts, said Debra Weinstein, director of graduate medical
education at Massachusetts General Hospital. Others may shift work
to nurses or physician’s assistants, who typically make $10,000 to
$40,000 more than a resident’s salary of $50,000.
“Teaching hospitals now face a seemingly reasonable and
certainly justified, but surprisingly difficult, challenge,”
Weinstein wrote in the Oct. 17 edition of the journal. “A
combination of approaches will be necessary, and implementing the
new rules regarding duty hours will be expensive.”
Hospitals should band together to find effective ways to
reduce hours and cut costs without lowering quality, she said.
Examples include using new technology, eliminating unnecessary
tasks, sharing responsibilities and using computer-based programs
to help residents get the time they need for education, she said.
“If we do not do it soon and do it well, the legislature
will do it for us,” Weinstein said. “One way or another, the
term `resident’ will soon become a misnomer.”
Simply cutting hours isn’t the answer, according to Jeffrey
Drazen, editor of the journal, and Arnold Epstein, an associate
editor. Programs must be substantially redesigned to improve
training and help residents learn the science of medicine, the
best way to deliver care and accountability, they said.
Long hours have “taught a central professional lesson about
personal responsibility to one’s patients, above and beyond work
schedules and personal plans,” they wrote in an editorial. “We
risk exchanging our sleep-deprived healers for a cadre of wide-
awake technicians.”
–Bloomberg
