Issue: February 2012
February 01, 2012
2 min read

Study: New physician training hour limits could be expensive

Issue: February 2012
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A 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 in the Journal of General Internal Medicine, come on the heels of recent duty-hour limits by the Accreditation Council for Graduate Medical Education for interns and medical residents.

According to a University of California Los Angeles news 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.

“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 K. 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,” Nuckols added.

According to the release, the researchers 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%.

  • Nuckols TK, Escarce J. Cost implications of ACGME’s 2011 changes to resident duty hours and the training environment. J Gen Intern Med. 2011; doi:10.1007/s11606-011-1775-9.
  • Disclosure: The researchers have no relevant financial disclosures.


William R. Beach, MD
William R. Beach

The current and proposed resident work restrictions are controversial issues. While patient and resident safety is paramount, costs are mounting in a time when resources are declining. Residents have long been an inexpensive source of high quality medical and surgical care. It is safer to limit work time, but at what point does resident education suffer? Will there be a point when less effective training and downstream errors that may arise from less training will outnumber the errors produced by sleep deprived residents? While attempting to do the right thing, we must be cautious not to let the pendulum swing past the target point of resident/patient safety to an unforeseen risk of patient jeopardy.

— William R. Beach, MD
Orthopedics Today Editorial Board member
Richmond, Va.
Disclosure: Beach has no relevant financial disclosures.