Shorter Hours for Residents May Come with Financial Consequences

Reduced residency duty-hour rules could increase hospitals' financial burdens and hinder education efforts, according to a report published in Minnesota Medicine.

Authors Dr. Allison Duran-Nelson, Dr. Joan Van Camp, and Dr. Louis Ling of the University of Minnesota suggest that new rules proposed by the Accreditation Council for Graduate Medical Education (ACGME) to limit first year residents' work-day hours to 16 could have the unintended consequence of causing "more stress for those physicians who want to be there for their patients." Longer shifts are currently the norm.

"It's primarily the residents that have a disagreement with the rules," said Duran-Nelson, director of the University's internal medicine residency program, in an interview. "As soon as we told interns they would no longer be allowed to do overnight calls and work more than 16 consecutive hours, they expressed some concerns about how that would affect their education."

The new, stricter rules scheduled to go into effect in July 2011 will replace ones that were instituted in 2003. They were devised by a 16-member ACGME task force made up of medical education, patient safety, and clinical care specialists.

Duran-Nelson noted that workday limits are the primary hangup with the new wide-ranging rules, citing a national survey indicating that 85 percent of residency program directors disagreed with this regulation, with nearly all saying they were in favor of other rules guiding time off and workloads.

ACGME said in a statement that the requirements for doctors-in-training are a "comprehensive package of interrelated standards designed to better match residents' levels of experience and emerging competencies, advancing both graduate medical education and safe quality patient care in the nation's teaching hospitals."

"Implementing [the rules] will require small changes in some programs and large changes in others, all with the goals of ensuring patient safety, that the next generations of physicians are well-trained to serve the public and that residents receive their training in a humanistic learning environment," said ACGME CEO Dr. Thomas Nasca.

Critics argue that while the patient-safety intent of the duty rules is good, many institutions already burdened with financial challenges will require significant, often costly staffing changes. "This could be particularly difficult right now for organizations with the economy as it is," Duran-Nelson said.

The University of Minnesota hospital plans to restructure its call systems at two of its three sites and hire several hospitalists as it creates a nighttime junior hospitalist rotation to help address certain ACGME requirements.

Duran-Nelson also believes that the rules will force residency programs to become more creative with their education efforts. For instance, she says students will probably gain more experience in labs and simulated environments rather than the clinical setting, which does have its advantages.

"Good simulation allows you to create virtually any type of clinical scenario," she said. "One would argue that this is actually a safer method because once the resident gets into the actual clinical situation, they will have experience already with less potential to do harm to a patient." 

See Also:

Revised Resident Duty Hour Standards Will Focus on Three Areas

Do Sleepy Medical Residents Jeopardize Patient Care?

The True Cost of Resident Work-Hour Restrictions