WASHINGTON, April 16 (UPI) -- New limits on the hours that medical residents work could have serious unintended consequences, a new study says.
Reducing resident workload to 60 hours per week would cost $2.9 million over five years for a typical surgical center with 20 residents and four fellows, according to a study in the April volume of the Archives of Surgery.
The study created a computer model of the surgical staffing needs of a tertiary hospital, then factored in changes in resident workloads.
"There's a fixed amount of patient care that needs to be done by a skilled labor force," said study author Francis Moore, professor of surgery at Harvard University.
"If residents don't do it, there has to be some way to replace the work," Moore told United Press International.
Medical residents are recent medical school graduates who are completing their training by getting hospital work experience in a chosen specialization. Residencies can last a couple of years or more.
Since 2003, accreditation requirements have limited hospital residents' work to 80 hours per week, with no single shift longer than 30 hours.
But research has found that fatigue is still a significant factor in both patient and doctor health. Recent studies have concluded that doctors who do not get enough rest are more likely to make mistakes that hurt patients. They are also more likely to injure themselves on the job by, for example, sticking themselves with needles, and to become depressed.
Policymakers are considering further tightening restrictions on the number of hours that residents can work, but that could wreak havoc on the way academic hospitals function, according to the study.
The reduced work by residents would have to be replaced by physician assistants, nurse practitioners or specially trained doctors called hospitalists.
Adding those workers would make up much of the predicted additional cost, but also strain labor markets, Moore said. All three categories of workers are relatively new, and thus in short supply. That could be further complicated by the fact that academic hospitals offer few opportunities for promotion in those specialties.
"We're dealing with a rapidly expanding need for inpatient services and no one to fill it," he said.
Reducing the hours could also harm the educational function of residencies, because residents who work more get more experience with more kinds of patients, Moore said. If those hours are reduced, doctors may not be prepared for practice.
It may also make hospitals more reluctant to take on residents at all, he added. There is a "contract between hospitals and residents for many generations. The hospital agrees to train them and they agree to do some work.
"If you cut back too much, hospitals could stop taking residents, or start asking them to pay tuition."
But others say the expense is worthwhile, given the danger of fatigued doctors giving patients care.
"If you're too sleepy to drive home from the hospital, you're too sleepy to operate on a patient at the hospital," Jay Bhatt, president of the American Medical Student Association, told UPI.
"Patient and physician safety is worth the money."
Hospitals with carefully redesigned work schedules have been able to implement the 2003 accreditation guidelines cost-effectively, he said, and more of the cost is recouped over time by reduced errors and increased resident productivity.
Instead of overworking residents to hold down cost, residency programs should get more funding from federal and state sources, he said.
"We need to find a good balance."
But simple gains in efficiency may not be enough to make reduced residency hours affordable for hospitals, according to the study. Even a 10-percent increase in clinical efficiency after three years would only save $700,000 of the nearly $3 million five-year cost, the model predicts.
"Any one of these solutions, even for a relatively small surgical service, is possibly prohibitively expensive," study author Moore said.
