Limiting resident physician work-hours might save money

BACKGROUND: Concerned that fatigue increases harmful errors by medical residents, Federal legislators in 2001 proposed limiting their work hours. In response, the Accreditation Council for Graduate Education in July 2003 introduced reforms that cap most residents' work hours at 80 hours per week. Previously, some residents worked 100 or more hours per week.

FINDINGS: Harmful errors in teaching hospitals cost $13.2 billion each year nationwide: $3.6 billion from increased hospitalization costs and $9.6 billion from higher outpatient medical care costs and patients' lost income. But the cost of reducing residents' hours by shifting work to other employees such as nurse practitioners and physician assistants would be much less, $673 million to $1.1 billion per year nationwide; thus, if this shift lowers harmful errors by more than 5 percent to 9 percent, the reforms would pay for themselves or save money for society overall, which includes patients, hospitals and insurers together. But for teaching hospitals to break even or save money, harmful errors would need to fall by 19 to 31 percent. This is because under the current system, teaching hospitals pay the cost of hiring additional employees to perform residents' work, and most savings from preventing medical errors occur after the patient has been discharged from the hospital.

IMPACT: Teaching hospitals are using a variety of strategies to limit resident work hours to 80 per week; previous studies suggest that some of these might increase rather than decrease errors. More research should determine which strategies prevent errors, and at what cost.

AUTHOR: The lead researcher is Dr. Teryl Nuckols, assistant professor in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA.

JOURNAL: The research appears in the October issue of the Journal of General Internal Medicine.

FUNDER: National Research Service Award Primary Care Fellowship.

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