Reducing medical residents' hours would cost $2.5 billion annually, study says

Implementing proposed reductions in the number of hours medical residents work could cost as much as $2.5 billion annually, according to a recent study published in the New England Journal of Medicine, the Baltimore Sun reports.

The study follows an Institute of Medicine report that proposed reducing the maximum hours that residents can work without sleep from 30 to 16, increasing the number of days they must take off and improving their supervision (Desmon, Baltimore Sun, 5/21).

In 2003, the Accreditation Council for Graduate Medical Education reduced the number of hours residents at teaching hospitals could work weekly from more than 100 hours to 80 hours. In the recent study, which was partially funded by IOM, researchers examined post-2003 literature on resident work hours and patient harm and evaluated it against additional labor costs. The authors concluded that the IOM recommendations "would be costly, and their effectiveness is unknown" (Shishkin, Wall Street Journal, 5/21).

Teryl Nuckols, the lead author of the study, said that teaching hospitals would most likely need to hire more residents and experienced physicians to take care of patients, which would likely cost each teaching hospital $3.2 million annually (Baltimore Sun, 5/21). The study was accompanied by an NEJM editorial in which the authors "strongly disagree" with the IOM recommendations, claiming that reducing resident work hours "leads to an increase in the number of handoffs in care, and this increase outweighs the potential benefits of reducing residents' fatigue." The accreditation council said that more research is needed before it decides whether to adopt the IOM recommendations. The council's decision will be announced in February 2010 (Wall Street Journal, 5/21).

The study is available online. The editorial also is available online.