Impact of 2011 Resident Duty Hour Requirements on Neurology Residency Programs and Departments

Abstract

Objective: In 2011, the Accreditation Council on Graduate Medical Education (ACGME) redefined resident duty hour requirements by reducing in-hospital duty hour requirements for residents in an effort to improve patient care, resident wellbeing, and resident education. We sought to determine the cost of adoption based on changes made by neurology residency programs and departments due to these requirements. Methods: We surveyed department chairs or residency program directors at 123 ACGME-accredited US adult neurology training programs on programmatic changes and resident expansion, hiring practices, and development of new computer-based resources in direct response to the 2011 ACGME duty hour requirements. Using data from publicly available resources, we estimated respondents' financial cost of adoption. Results: In all, 63 responded (51% response rate); 76% were program directors. The most common changes implemented by programs were adding night float systems (n ¼ 31; 49%) and increasing faculty responsibility (n ¼ 26; 41%). In direct response to the requirements, 21 programs applied to ACGME for 40 additional residents, 29 of which were fully covered by institutional funds. In direct response to the requirements, nearly half of the departments (n ¼ 26) hired individuals for a total of 80 hires (or 64 full-time equivalents), most commonly mid-level practitioners. The total estimated cost to responding departments was US $12.7 million or US $201,000 per department annually. When projecting expenses of planned changes for the following year, costs increased to US $360,000 per department, with 5-year costs exceeding US $1 million. Conclusions: The most recent restriction on resident duty hours comes at substantial cost to neurology departments and residency programs.

Duty hours restriction for our surgical trainees: An ethical obligation or a bad idea?

“…Although later studies have failed to show consistent improvements in patient outcomes after instituting resident duty hours restrictions, surgeon burnout and perception of well‐being have been directly associated with the incidence of medical errors; thus, efforts to improve well‐being in surgeons, house officers, and nurses may indirectly lead to improvements in patient care and avoidance of errors . Whatever may be the case with the effects on patient care, one thing is clear: the duty hours restrictions imposed by the ACGME have had a major financial impact on teaching hospitals, with this unfunded mandate leading to an average increase of $1 million in personnel cost for each residency program over a 5‐year period as hospitals hire additional house officers or attending clinicians to cover after‐hours emergencies . Extrapolating to include the multiple specialty services that are involved with after‐hours coverage, this cost escalates to several million dollars per year for larger hospitals.…”

Challenges to neurology residency education in today's health care environment

“…9 This can represent a significant stress on a department and resources need to be made available to offset these costs. However, residency programs need to be cautious about focusing on placating and pleasing residents and review committees at the cost of focusing on education.…”

“…Some programs have hired mid-level providers to take on less educational work, although it has been estimated that these changes may result in a 5-year cost exceeding $1 million per department. 9 This can represent a significant stress on a department and resources need to be made available to offset these costs. Expanding the residency program is another way some programs have dealt with this problem, but according to ACGME an educational rationale should really be the basis for such an expansion, not a service requirement alone.…”

“…In other words, the educational environment needs to be thoughtfully adapted to meet work‐hour demands. Some programs have hired mid‐level providers to take on less educational work, although it has been estimated that these changes may result in a 5‐year cost exceeding $1 million per department . This can represent a significant stress on a department and resources need to be made available to offset these costs.…”

“…Many programs have had to implement a night float system, but for these programs to be successful, faculty must be diligent about finding ways to provide adequate feedback on overnight performance. In some instances, faculty responsibilities may need to increase to adapt to the residency work hours, and in one study, faculty reported taking over responsibilities such as leading patient and family meetings, documenting events, writing orders, and coordination of postdischarge care; this may have unintended consequences on the value of education, and programs need to be particularly cautious against residents losing time to practice valuable skills.…”