Patients who are cared for in teaching hospitals in this country may or may not be aware of the dynamic process of resident physician coverage, sign-outs, and care transitions/hand-offs between training care teams; but one aspect of graduate medical education (physician residency training) should be at the forefront of site administrators, program directors, and of course, the patients themselves: resident fatigue.

The national body which accredits residency training programs across the country is looking at the results of a recently published NEJM study that finds, among other things, an actual cost of care increase in institutions which reduce the number of hours physicians-in-training actually hone their craft. The NEJM study’s authors attack findings from a 2003 Institute of Medicine (IOM) report in which halving the numbers of hours resident physicians work daily would benefit patient safety, care, and increase physician performance. The authors cite that the performance benefits would be outweighed by the risks of care disruption, significant increased costs to teaching hospitals, and overall unknown outcomes.

On the surface, teaching centers have much to lose if they are forced to pay more for patient care to make up for reduced resident training hours; they have about a year to plan for such an action, if the accrediting body agrees with IOM findings. | LINK

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