The Institute of Medicine is recommending “rapid implementation” of its proposed plan to further restrict medical residents’ work hours. The plan includes a 5-hour nap during extended shifts, a strict 16-hour cap on shifts without naps, reduced workload, and more days off.
But at what price?
It seems like common sense that better rested doctors make fewer errors and contribute to better patient care, but data from several large-scale studies does not back up this belief. It is likely that any benefit gained from limiting doctors’ time in the hospital is offset by errors that arise when patient care is transferred to another physician. And data has shown that most hospital errors are not necessarily caused by resident fatigue in the first place.
And, there is the overwhelming price tag. It’s estimated that it would cost the country’s teaching hospitals about 1.6 billion dollars annually to hire substitute workers to cover for residents.
We need more research on this issue. I support the position of The New England Journal of Medicine, whose editorial last month recommended that this major policy decision adhere to the standards of evidence-based medicine and comparative effectiveness. We simply don’t have the evidence that the benefit to patients is ultimately worth the cost.
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