Cost Implications of Reduced Work Hours and Workloads for Resident Physicians

The Institute of Medicine recently made new recommendations to reduce the work hours and workload of residents. This economic analysis suggests that implementation of these recommendations would be costly (annual labor costs, $1.6 billion), but if they are highly effective in reducing patient harm, they may be cost-effective. The Institute of Medicine recently made new recommendations to reduce the work hours and workload of residents. This economic analysis suggests that implementation of these recommendations would be costly, but if they are highly effective in reducing patient harm, they may be cost-effective. Fatigue among resident physicians has been linked to medical errors, motor-vehicle crashes, and occupational injuries. 1 – 3 In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented reforms to reduce resident fatigue. 4 Studies analyzing these reforms have shown equivocal results, however; two studies showed absolute reductions of 0.25 to 0.70 percentage point in mortality among medical patients, whereas several other studies showed no changes. 5 – 10 At least three factors could explain the negative findings. First, resident surveys indicate that nonadherence to the limits has been widespread. 11 – 16 Second, the reforms increased handoffs of patient care from resident to resident, which . . .