I’ve always wondered how much more staff would be needed to compensate for restricting resident work-hours and mandating naps.
The NEJM provides the answer in their perspective piece on the issue.
Two researchers how studied that exact question, using models based on various work-hour restriction scenarios. They found that “nationally the health care system would need to create and fill new full-time”“equivalent positions for 229 nursing aides, 45 laboratory technicians, 320 licensed vocational nurses, 5984 midlevel providers (nurse practitioners or physician’s assistants), and 5001 attending physicians; if hospitals were to increase the number of residents instead, an estimated 8247 additional residency positions would have to be created.”
That’s a lot of additional pressure to place on already short-staffed and budget-pressured hospitals.
Which is why lengthening residency training seems to be the only viable solution to satisfy both the patient safety and cost demands.
Related posts:
- Resident work hour restrictions
- Are resident work-hour restrictions doing a disservice?
- Resident work hour restrictions
- Old-school doctors on resident work-hour restrictions
- Do physician assistants need work-hour restrictions too?
- Do resident work-hour restrictions increase surgical complications?
- How work-hour restrictions harms resident surgeon training
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Maybe, the health care industry should ask Congress for some “free money”.
We are bailing out every big corporation in America. Why are we not bailing out the health care industry? Why is the auto industry “more special” than the health care industry?
If hedge fund Cerberus’ top mgmt. is able to keep its big bonuses as well as get “free money” for Chrysler, every company in America should be entitled to that “free money”.
http://www.thenation.com/doc/20081229/howl?rel=rightsideaccordian
I’m surprised RNs aren’t on that list of new positions needed. 37 hours in Denmark? Seriously? That’s not even full time. I worked 76 hrs last week and my floor was still short on nurses every single shift. What happens if they start limiting our hours?
If we close down the crappy residency programs that are already run only for the value of cheap labor to the hospitals and which take marginal residents from off-shore schools, then the remaining programs could increase residents without increasing the net supply to the nation–at least that is true in my specialty.
If we come up with a way to stop all the unnecessary medical care delivered–some of it defensive, some of it pandering to people’s love of tech, some of it defending only the specialists “need:” for 400,000 a year to live—we would free up way more than enough attending physicians.
All of that would still leave the fact that you have cut resident contact hours and net experience and need to increase the time to keep the same experience.
From an educational point of view….limiting hours also limits exposure to education. So that either means that residents need to study outside of their work hours. They need homework, assignments etc to encourage and monitor their progress. In the US system there is waaaay too much time wasted on clerical duties, especially in the early years. How about getting PAs and office assistants to manage all non-medical issues to free up residents to spend more time on learning. It’s the only way to provide sufficient exposure without making residency a 10 year process!
Which, I’m certain, is the same intellectually corrupt argument that Southern white landowners used 150 years ago to argue against letting the slaves go free. “What!? It’ll be too damned expensive. How will I ever be profitable having to actually *pay* people a decent working wage to tend the crops??”
Really… Changes mean effort, work, and, well, doing something different. And that means providing more staff to provide the level of care that hospitals should’ve been providing for decades (but declined to do because of the cheap doctor labor that was available to them). It’s a shame you seem to have become an apologist for this broken, abusive system, Kevin.
Of course if residency is lengthened fewer and fewer may choose to go to medical school particularly given the increased debt that was also the subject of an article in this week’s NEJM. (I blogged on this at “The Country Doc Report”.
What’s wrong with creating more resident positions, while increasing the number admitted to Medical Schools? Isn’t there a shortage of Doctors already? This could be an opportunity to address two problems at once.
Anon 12:38
Very simply because it cost’s more money. The feds are trying to cut medical costs not increase them.
If further time cuts are required then residency will need to be lengthened and resident scut work will need to be radically reduced. Anybody who has done a residency can give examples of drawing blood, getting consents for medical records (and even faxing them), playing courier throughout the hospital, etc, etc. Frankly work that wouldn’t be done by an MD if they work considered cheap labor by the ivory tower.
PS: IMO new residency grads have no clue how private practice functions.
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