The Institute of Medicine wants to further restrict the amount of work medical residents do.
The 80 hour cap on work-hours aren’t routinely enforced, which puts patients at risk for medical errors by sleepy doctors.
The committee smartly addressed the problems with patient hand-offs, a necessary evil when more doctors are involved with a patient’s care. Another recommendation is a mandatory five-hour nap after working more than 16 hours.
The biggest problem with instituting these suggestions is cost. Hospitals are already fiscally squeezed, and will have to hire additional staff to compensate for the reduced amount of work that residents are mandated to do. This includes hiring more hospitalists to staff “non-teaching” services, mid-levels to round on routine patients, and ancillary staff to reduce the scut burden on residents.
Whether hospitals are willing to comply is still in question.
Robert Centor is concerned about the impact these further restrictions will have on teaching, saying already “we have residents who cannot attend noon conference because their ’shift’ is over. How does that help the resident?”
Another concern is that the real world post-residency has no such work restrictions. How will these newly graduated doctors handle a world where they may be forced to work more than 16 hours straight, or 80 hours a week?
Related posts:
- Would you want a tired doctor who knows you, or a rested one that doesn’t?
- Poll: Are the Institute of Medicine’s recommended restrictions on residents’ work hours good for medicine?
- Do physician assistants need work-hour restrictions too?
- Work-hour restrictions = scut management
- Teaching medical procedures to interns and residents
- A 48-hour physician workweek will kill patients
- "So you work after you’ve been on call?"
{ 2 comments }
1) Under Commie Care in England, surgeons, pampered in their residencies, go home at 5 PM, come hell or high water. The waiting time for emergency surgery, where the patient is bleeding, and the blood replacement bag has to be squeezed and repeatedly changed by the nurse? 6 days. The idea of the US schedule is that patient care comes before doctor comfort.
2) One has to contrast values rendered. The medical resident likely enhances health, and returns 10,000% on cost by patients’ returning to work better. He is lucky to get $50K salary from the lawyer controlled health provider reimbursement system of Medicaid or Medicare. The first year law associate gets $150K, and destroys $1 million in value by lawyer gotcha, paper shuffling in rent, and deterrence of productive economic activity.
Kevin,
At least one physician would disagree.
http://www.nytimes.com/2008/12/05/health/05chen.html?_r=1
“As Dr. Michael M. E. Johns, chairman of the expert panel, remarked at a public briefing on the report on Tuesday, “While the science on sleep and human performance provided a rich evidence base for duty hour adjustment, there was limited data on the impact of the 2003 limits on actual hours worked, scheduling practices, education and patient safety.” In other words, in the realm of resident duty hours reform, there isn’t really enough information to make solid evidence-based recommendations.”
Read the whole thing.
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