Study: New physician training hour limits could be expensive

Nuckols TK. J Gen Intern Med. 2011;doi:10.1007/s11606-011-1775-9.

A recently published study found that new limits on hours that physicians-in-training can work may prove costly for teaching hospitals in the United States — which will reportedly need to spend up to $1.3 billion a year or more to effect the changes.

The findings, published online in the Journal of General Internal Medicine, come on the heels of the new duty-hour limits by the Accreditation Council for Graduate Medical Education for interns and medical residents. The changes were implemented July 1, and also included related changes to the training environment.

According to a University of California Los Angeles release, the findings estimate teaching hospitals will have to spend an aggregate $400 million to $1.3 billion each year to carry out the new hour limits and related changes. The reforms are intended to reduce medical errors by physicians-in-training that result from fatigue due to long work hours.

Struggle for some hospitals

The study noted that the costs could be worth it, but cautioned some hospitals may be unable to keep up with the changes.

“Given the effort and money that teaching hospitals are investing in implementing these new duty-hour limits, many people hope that these changes will reduce the numbers of patients being harmed by medical errors, as well as the number of residents falling asleep at the wheel after long hours on duty,” study author Teryl Nuckols, MD, stated in the release. “Our analysis shows that if the reforms are successful, they are likely to be a good value for the money from the societal perspective.”

“However, some teaching hospitals may struggle with the cost of implementing the reforms because there is no funding for doing so,” she added.

Study methods and findings

According to the release, the researchers for the study drew from published literature and publicly available data resources to create models examining the costs of hiring substitutes to perform the work of residents — and the potential effects of changes on rates of harmful medical errors and their associated costs.

Based on “the most optimistic assumptions” about the implementation of changes, the authors found the costs will be at least $177 million annually nationwide. Less optimistic assumptions, they noted in the release, put the nationwide costs up around $982 million annually. Changes to the training environment, they calculated, will cost an additional $204 million each year.

The study found that if medical errors fall by 3% — what the study deemed as “a modest decline” — the reforms could be cost-effective to society. However, teaching hospitals would still be losing money unless errors decline by anywhere from 7.2% to 25.8%.

Disclosure: The researchers report no relevant financial disclosures.

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