Financial Impact of Intern and Resident Duty Hour Changes on Training Institutions.

Interns are physicians who are in their first year of specialty training after graduating medical school. Residents are physicians that are still undergoing specialty training but have completed their internship year. Traditionally, these physicians in training have worked very long hours (ask my lovely wife!). This worked well for the training institutions, as interns' and residents' salaries are paid for by Medicare, meaning hospitals got cheap physician labor. However, medical errors have been blamed on physician fatigue and some physicians have had car accidents after falling asleep behind the wheel after being up all night on call. Over the past several years, there has been a movement to limit work hours of interns and residents in an effort to improve patient safety and physician health. In July 2011, new guidelines were instituted where interns can only work a maximum of 16 hours continuously and must have on-site supervision at all times. Residents can work upto 28 consecutive hours when they are on call.

There is a study in the July edition of the Journal of General Internal Medicine that reviewed how the new work hour limits will affect the financial health of the hospitals that train interns and residents. The results showed that the duty-hour changes would cost $177 to $982 million annually on a nationwide scale. The associated training environment changes will cost an additional $204 million annually. If medical errors decline by 7.2-25.8%, net costs to major teaching hospitals will be zero.

To make up for the extra hours not worked by interns and residents, hospitals would have to hire other providers. The cost of using these other workers depends on the type of worker used to substitute for the interns and residents. The study showed that the total direct annual cost nationwide would be up to $1.34 billion using nurse practitioners/physician assistants, $1.64 billion using attending physicians, $820 million hiring additional residents or $1.42 billion using a mixture of substitutes.

The study authors concluded that if the reforms in duty hours are successful at reducing patient errors, then the cost associated with the new rules will be a good value for the money from a societal perspective.