New Doctor Intern Inspections to Cost Hospitals $15,000 Yearly
Hospitals will be required to reduce physician interns’ working hours and be inspected yearly to ensure the first-year doctors are properly supervised and getting enough time off under newly proposed rules.
The Accreditation Council for Graduate Medical Education, a nonprofit organization that evaluates more than 8,800 U.S. residency programs, outlined the proposed policies in a paper published today in the New England Journal of Medicine. The procedures would trim the length of time interns can be on call to 16 hours from 30 previously and require greater supervision of the new doctors.
Long schedules for interns, medical school graduates in their first year of hospital training, were once a rite of passage, with reports that some new doctors worked 140 hours a week. In July 2003, the accreditation council restricted intern working hours to no more than 80 a week and 30 at one stretch after a 1999 Institute of Medicine report found medical errors claimed 44,000 to 98,000 lives annually.
“Patient safety in teaching hospitals is not just about duty hours, it is much more about supervision,” said Thomas J. Nasca, chief executive officer of the council, on a conference call. Among the responsibilities are “controlling workload, establishing effective teamwork and communications, establishing policies and procedure for transitions in care,” he said.
Unannounced Visits
A 2008 report by the Institute of Medicine, a nonprofit U.S. government advisory group, said that a lack of adherence to the current limits on duty hours was common and underreported. The report recommended the council execute unannounced visits and strengthen whistle-blower processes, where residents report violations of work hour limitations.
The institute gave the council “two years to implement most of these changes,” according to the accreditation group’s July 2009 newsletter.
The report estimated the total cost to U.S. hospitals of hiring staff substitutes for residents’ excess time may be as much as $1.7 billion.
The council has commissioned an external review of the “financial implications” for hospitals of the new standards for physician interns, Nasca said today.
The reduction in hours for physician interns will challenge traditional teaching hospitals financially, said John Mendelsohn, president of the Houston-based University of Texas MD Anderson Cancer Center, in an interview today.
‘Cat Naps’
“I am a product of the old system -- you learn how to take cat naps,” Mendelsohn said. “But I’m for the new system because frankly, it would be nice to have more time at home” for the interns, he said.
Medical educators may comment on the proposed rules until Aug. 9, the association said. The changes will likely take effect in July 2011, the organization said.
“If residents work fewer hours, then someone has to pick up the slack and it’s either going to be faculty or physician extenders,” said Tom Blackwell, who oversees 600 interns as associate dean of graduate medical education at the University of Texas Medical Branch in Galveston, Texas. “So costs are going to go up. It’s tough, everyone’s budget is tight, I just think it’s something we’ve got to do.”
To contact the reporter on this story: Arielle Fridson in New York at afridson@bloomberg.net.
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