| The increased financial burden of further proposed orthopaedic resident work-hour reductions. | |
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MedLine Citation:
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PMID: 21471411 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Increased funding for graduate medical education was not provided during implementation of the eighty-hour work week. Many teaching hospitals responded to decreased work hours by hiring physician extenders to maintain continuity of care. Recent proposals have included a further decrease in work hours to a total of fifty-six hours. The goal of this study was to determine the direct cost related to a further reduction in orthopaedic-resident work hours. METHODS: A survey was delivered to 152 residency programs to determine the number of full-time equivalent (FTE) physician extenders hired after implementation of the eighty-hour work-week restriction. Thirty-six programs responded (twenty-nine university-based programs and seven community-based programs), encompassing 1021 residents. Previous published data were used to determine the change in resident work hours with implementation of the eighty-hour regulation. A ratio between change in full-time equivalent staff per resident and number of reduced hours was used to determine the cost of the proposed further decrease. RESULTS: After implementation of the eighty-hour work week, the average reduction among orthopaedic residents was approximately five work hours per week. One hundred and forty-three physician extenders (equal to 142 full-time equivalent units) were hired to meet compliance at a frequency-weighted average cost of $96,000 per full-time equivalent unit. A further reduction to fifty-six hours would increase the cost by $64,000 per resident. With approximately 3200 orthopaedic residents nationwide, sensitivity analyses (based on models of eighty and seventy-three-hour work weeks) demonstrate that the increased cost would be between $147 million and $208 million per fiscal year. For each hourly decrease in weekly work hours, the cost is $8 million to $12 million over the course of a fiscal year. CONCLUSIONS: Mandated reductions in resident work hours are a costly proposition, without a clear decrease in adverse events. The federal government should consider these data prior to initiating unfunded work-hour mandates, as further reductions in resident work hours may make resident education financially unsustainable. |
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Authors:
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Atul F Kamath; Keith Baldwin; Lauren K Meade; Adam C Powell; Samir Mehta |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of bone and joint surgery. American volume Volume: 93 ISSN: 1535-1386 ISO Abbreviation: J Bone Joint Surg Am Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-04-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0014030 Medline TA: J Bone Joint Surg Am Country: United States |
Other Details:
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Languages: eng Pagination: e31 Citation Subset: AIM; IM |
Affiliation:
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Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Silverstein Pavilion, Philadelphia, PA 19104. samir.mehta@uphs.upenn.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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