Health Care:

Reduction in Resident Physician Work Hours Will Not Be Easy to Attain

HRD-93-24BR: Published: Nov 20, 1992. Publicly Released: Nov 20, 1992.

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Pursuant to a congressional request, GAO reviewed resident physicians' work hours and the quality of care delivered, focusing on: (1) resident sleep deprivation and its impact on the quality of care; (2) sleep deprivation effects on nonphysician job performance, safety, and health; and (3) the effectiveness of implementing regulations to limit residents' hours.

GAO found that: (1) long work hours and sleep deprivation had not jeopardized the quality of care provided by resident physicians; (2) resident physicians cited excessive fatigue as the cause for errors in patient care; (3) the medical community adopted compromise guidelines which stated that residents could work 96 hours or more per week; (4) New York was the only state that restricted the number of hours a resident could work; (5) New York regulations limited residents' work hours to no more than 80 hours per week and required that resident supervision be provided according to experience; (6) the initial costs of implementing and maintaining New York's requirements were estimated at $227 million; (7) medical associations warned that rigid enforcement of mandatory limits on work hours could force closure of some hospitals; (8) Ontario restricted residents' and interns' hours to 60 hours per week; (9) England and New Zealand limited residents and interns to a maximum of 72 continuous hours, and Australia required providers to pay overtime for hours worked in excess of 40 hours per week; (10) resident physicians work hours can be limited legislatively by attaching conditions to Medicare participation; (11) decreased work hours needed to be replaced by increasing the amount of direct medical care and supervision provided by faculty and attending physicians, utilizing nurse practitioners, nurse midwives, or physician assistants for on-call hours, and providing additional auxiliary support staff; (12) decreasing resident physician work hours could force some hospitals to close, or curtail services provided to indigent patients; and (13) hospitals claimed that attaching work-hour requirements to Medicare would increase costs, unless the government reimbursed them the cost.

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