Cost Implications of Reduced Work Hours and Workloads for Resident Physicians

Abstract

Implementing the four IOM recommendations would be costly, and their effectiveness 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.

Regulation of Medical Student Work Hours: A National Survey of Deans

“…7 Since implementation, these limitations have created shortages in the physician workforce immediately available to manage patient care, because part of the role of residents in hospital settings is service. 8,9 They have disrupted residents' contact with patients and continuity of their patient care 10 -13 and, because of a resident's inability to remain in the hospital after a specific number of hours, have decreased resident education at scheduled attending rounds, conferences, and seminars. 10,14 -17 To date, there have been no mandated adjustments to the intensity and volume of work or to the amount of resident supervision required in the training environment.…”

Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop

“…Using additional residents instead of physician extenders, at least 8% more residency positions would be required. 15 Congress has not budgeted to cover for these additional expenses. Possible negative strategies teaching hospitals could use to manage the additional costs include reducing residents' salaries, increasing the workload of faculty physicians (without increasing compensation), increasing charges to patients, decreasing profit margins, reducing clinical services, and/or allowing quality of care to decline.…”

Restricting resident work hours

“…Implementing work hour restrictions for residents will have significant economic ramifications. Initial estimates for implementing all of the 2008 Institute of Medicine recommendations in the United States were in the range of 1.6 billion U.S. dollars per year (82). For the ACGME regulations that were put in place in July 2011, cost estimates are lower, but still substantial, ranging from $820 million to $1.64 billion (U.S. dollars) per year depending on the strategy used to address the predicted workforce shortage the restrictions will create (83).…”