Additionally, the 2011 rules resulted in a decrease in "continuity of patient care, intern and nurse perceptions of quality of care, and educational opportunities from teaching and patient care," Desai wrote.
In an accompanying invited commentary, Lara Goitein, MD, and Kenneth M. Ludmerer, MD, of Christus St. Vincent Regional Medical Center in Santa Fe, NM, said the current limitations are "too inflexible."
Not only has the policy change created a situation that leads to increased medical errors, they wrote, but "limiting work hours without commensurately decreasing workload exacerbates the already extreme work compression for residents." In other words, these trainees have to do more in less time.
"Residents still perform most of the work, but are now racing the clock."
Teaching hospitals have focused on work hours, rather than on workload because they "are heavily dependent on the work provided by residents" and reassigning patients to non-resident services "is more expensive than implementing work hour limitations, at least in direct costs.
Goitein and Ludmerer say the situation can be repaired in two ways. First, teaching hospitals can increase resident training positions to reduce work intensity, and they can shift some patients to non-resident providers.
"Of course these measures are costly and will face substantial hurdles," they wrote, but there is some evidence that making adjustments can pay off, and even pay for itself through reduced 30-day readmissions, shorter lengths-of-stay, and reduced need for intensive care unit admission.
In sum, they argue: "Residents should no longer be asked to do an increasing amount of work in less time and with less flexibility."