Attendings limited to 80 hours soon?

[Faebinder]

---

Members don't see this ad.

Heard a couple of surgery attendings talking about this. They seem to think the discussion will happen within the next 5 to 7 years. This oughta be interesting.

Personally I dont think it will happen... but when you hear two attendings talking about it, you start having doubts.

 

[drfunktacular]

Heard a couple of surgery attendings talking about this. They seem to think the discussion will happen within the next 5 to 7 years. This oughta be interesting.

Personally I dont think it will happen... but when you hear two attendings talking about it, you start having doubts.

Seems like all the same arguments would apply, e.g., compromise of patient care by post-36hr caregiver, etc.

 

[docB]

Seems like all the same arguments would apply, e.g., compromise of patient care by post-36hr caregiver, etc.

Some of the same arguments will be made for such a limit but it will be a totally different ballgame. To limit the hours of residents you only have to convince the ACGME. To limit attendings would be a much tougher problem.

You could try to have decisions made by the individual state med boards but there are 50 of them and they have no interest in assuming the monitoring and enforcement responsibilities of something like a work hour limit.

You could try to convince the hospitals or hospital associations but they don't tend to work well together and could use refusal to market. "Come work at X Memorial and work as much as you want." Even if they did try to adopt they have a very limited ability to tell docs what they can or can't do. They could exert more control over contracted docs like EM, Rads, Gas, Path, etc. but even then, we're contractors, not employees.

You could try to have the med mal insurers make their insured docs work fewer hours but again they don't want to assume the monitoring/enforcement duties.

There is precedent for this. Truckers are limited in the hours they can drive. But that system is run by the DOT and enforced by the state highway patrols which have always worked in concert to regulate trucking. The infrastructure was there when the regulations were created.

There's also just something wrong with telling someone how much they can work. In medicine that is exactly the same as telling someone how much money they can make.

 

[Blade28]

Don't know if this would work - who would be cross-covering for the attendings when they'd gone "over" their 80 hours? Other attendings? Surgical hospitalists? Residents?

It doesn't work that way in practice. And who would regulate this? The hospital?

 

[Dr. Wexler]

And who would regulate this? The hospital?

I would forsee the Federal Gov't using Medicare money as a carrot. Similar to EMTALA. Only hospitals whose doctors work 80hrs/week or fewer are eligible for Medicare resimbursement.

Managing the hours of docs in private outpatient-only practices would be more difficult. Perhaps the would be forced to document the hours, and maybe even have a plan in place for who will take care of their patients once they go over the 80 hr limit.

 

[Faebinder]

I would forsee the Federal Gov't using Medicare money as a carrot. Similar to EMTALA. Only hospitals whose doctors work 80hrs/week or fewer are eligible for Medicare resimbursement.

Managing the hours of docs in private outpatient-only practices would be more difficult. Perhaps the would be forced to document the hours, and maybe even have a plan in place for who will take care of their patients once they go over the 80 hr limit.

Gosh, are you working for Jahco now or do diabolical thoughts always run in your mind? Nice thinking there.

 

[Blade28]

I would forsee the Federal Gov't using Medicare money as a carrot. Similar to EMTALA. Only hospitals whose doctors work 80hrs/week or fewer are eligible for Medicare resimbursement.

Good point.

What I meant was, how would this be enforced? Self-reporting will achieve nothing (except lies and subtle cover-ups). Certainly it will be much harder to make sure attendings leave post-call (god what a concept).

 

[Winged Scapula]

As docB notes, outside of academic hospitals, very few physicians are contracted employees, so the hospital's rules would have little bite against them. They could regulate the hours their contracted physicians work in their facility, but what about physicians that work at multiple places?

Is John C Lincoln Hospital going to call Mayo who's going to call Banner Thunderbird , etc. and tell on me if I work more than x number of hours per week?

Much more feasible for academic medical centers with all physicians on staff and rules about working outside of the system, not so easy in the vast majority of this country where health care is provided. Since many of us trained at academic medical centers, I'm not sure that users realize that most hospitals do not employ physicians, especially in the non-HOBs arena.

The states cannot even get it together to work on credentialing and license verification. I can just imagine what chaos would ensure if we added another division: work hour regulatory staff.🙄

 

[Dr. Wexler]

As docB notes, outside of academic hospitals, very few physicians are contracted employees, so the hospital's rules would have little bite against them. They could regulate the hours their contracted physicians work in their facility, but what about physicians that work at multiple places?

Is John C Lincoln Hospital going to call Mayo who's going to call Banner Thunderbird , etc. and tell on me if I work more than x number of hours per week?

Of course it would be difficult to enforce work hours for non-employed physicians. It could be an honor system as simple as "Doc, you need to sign this piece of paper attesting that you haven't/won't work more than 80 hrs in a week". Or it could be more onerous, "log all your work hours as a physician and have them available for random or regular inspection" or even "submit a plan with us that proves you have a mechanism in place to not work more than 80 hours(limited office hours, shared call, backup coverage, etc.)".

How hospitals "enforce" these work rules could either be mandated specifically by the government or left as open as "make sure none of your docs work more than 80 hours" with individuals hospitals left to their own devices.

Hospitals breaking these rules could be fined by government regulators or subject to qui tam actions by citizens who catch them(if medicare reimbursement were tied to these work hour rules).

I'm not coming out in favor of this. (I think there is a big difference between a resident who is forced to work long hours in order to complete his training and an attending who has much more say over his work schedule.) Just pointing out the myriad of ways the government could enforce an 80 hour limit.