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Work-Hour Limits for Surgery Residents Can Be Costly

Computer model predicts substantial cost increases to replace residents with physician assistants

TUESDAY, April 17 (HealthDay News) -- Decreasing surgical residents' work hours and using alternative providers can be costly for teaching hospitals, but increasing departmental efficiency can reduce the cost, according to a computer modeling study published in the April issue of the Archives of Surgery.

Francis D. Moore Jr., M.D., of Brigham and Women's Hospital and Harvard Medical School, in Boston, and colleagues used a computer model to help predict future staffing requirements, expense, and educational impact for the surgery service at a teaching hospital. Variables in the model included distribution of residents, fellows, and physician extenders; salary/wages; and work hours, among others.

The authors found that decreasing resident work hours to 60 hours per week and replacing the hours by hiring 10 physician assistants would increase costs by $1,134,000. Including a day of didactic and simulator training for residents would increase costs by $568,000. A 10 percent improvement in efficiency, perhaps through advanced information technology, could mitigate more than 20 percent of these costs.

"The potential for simple efficiencies to mitigate some of this expense suggests that traditional patterns of care in teaching hospitals will have to change in response to educational mandates," the authors wrote. A transcript from a discussion with surgical specialists follows.

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