"Nobody wants procedures or important decisions to be made by exhausted, blurry-eyed, muddle-brained doctors."
Ref.:<http://www.medscape.com/viewarticle/575560_2> [see Ref. below]
Read some quotes ,below the fold, taken from an attending physicians comments, about Resident’s Pediatric coverage for patient care in an American teaching hospital. Then, please reflect on a potential problem which I personally have concern about for the future success of any
National Health Care plan IF a National Health Care ( NHC ) program will be enacted that will not provide for adequate physician recompense for the many hours that physicians will need to spend in providing adequate patient care especially given the long developing pent up need for such.
"In 2003 the Accreditation Council for Graduate Medical Education (ACGME), which accredits U.S. medical training programs, instituted rules for Resident physician work hours, sometimes called "the eighty-hour workweek"; the new rules limit residents' duty hours to no more than eighty hours a week.Ref:http://www.medscape.com/viewarticle/575560_2
These rules were developed both to protect patients from potentially unsafe medical practices by sleep-deprived physicians and to improve working and learning conditions for residents. The work rules, among other stipulations, limit both the number of consecutive days in a week and the number of consecutive hours in a shift that a physician-in-training can work; in addition, the rules require rest periods of at least ten hours between shifts."
"To accommodate to the 2003 rules. "Stop-gap measures, designed to provide physician care to all patients around the clock, seven days a week, are found in every teaching hospital in the United States. By limiting the number of work hours of each resident, however, the new ACGME rules have effectively decreased the hospital's resident physician workforce by 25 percent—in other words, a full quarter of them have gone missing" since they are no longer permitted to work" the seemingly endless hours of on duty coverage that I (dollparty) experienced during my post medical school training back in the late 1950s & early 1960s.
"The intent of the stop gap (at the hospital in the article referenced in the URL above) was to form medical teams that would work in rotating shifts, thus providing the physicians with adequate time off. The total impact of the new rules on physician performance and learning, as well as on patient care and safety, remains largely unknown however.
As a result (of the stop gap measure), several times a day, responsibility for patient care shifts as it is passed from team member to team member."
Under the above program, " responsibility for the care of a very ill patient during the current eight-or ten-or twelve-hour shift today didn't provide for that same Resident’s care of that patient
yesterday and probably that Resident won't take care of him (that same patient) tomorrow. The Resident doesn't know the full story of this patient's recent illness, doesn't know the long-term plans, and wasn't part of the previous decision making to design the patient's current treatment".
If an intern, for example, continues on duty beyond the dictates of the rules, a training program might be cited for noncompliance. "The penalty for too many citations: probation for the training
program or possibly withdrawing the program's ACGME accreditation. A training program on probation or without accreditation has an extremely hard time attracting excellent resident physicians."
Perhaps it falls to the attending physicians, in that mentioned Pediatric hospital to make the above program function seamlessly because, as the attending doctor in the referenced URL points out,"The reason that the doctors at my Children's Hospital are disappearing or aren't there when they're needed is, simply, inadequate resources to compensate for the restrictions of the new work rules and the resulting (Resident hours) workforce reduction." As already mentioned when Internes & Residents there reach their allotted work hour limits they must cease & desist and , I assume , that there is not enough funding available to hire additional Residents to meet the never ceasing patient work load.
The American public must not fool itself. Funding for any National Health Care program and physicians earnings are likely to be very big issues for any such plan IMHO.
Just "because residents traditionally worked in hospitals in the name of receiving education and because altruism is a hallmark of doctors, physicians-in-training had, ( in years prior to 2003 ) provided a considerable amount of clinical care while working long hours for relatively short pay."
I personally can not get myself to see the Physicians working in a NHC program volunteering to do the same.
Despite any feelings of altruism, I have personal doubts that physicians, once finished with their initial training years, and many burdened with staggering debt,acquired while attending medical school, are going to want or will submit to a continuing career of low pay PLUS long work hours in any NHC program.
Nor, does it seem to me that...if the before mentioned Pediatric hospital’s "stop gap program", would be adopted as a possibility for a functioning method of practice for doctors who have completed their training, and who are anticipated to be working in a future NHC system... it (NHC) will be able to provide for quality medical care for American patients IF said doctors also have limited work hours implemented specifically in order to be able to limit doctors pay in effort to hold a health care system’s costs down.
I have read recently that there is now an incipiant Family Practice physician shortage in the works today in this country. The root of this apparently being the long work hours and much curtailed income for Family Practicioners compared to specialty practices.
With only some 100,000 Resident Physicians in the training stream currently,
(Ref.:ibid) the likely hood ,as I have interpreted it from the details in the above referenced article, that the "stop gap measure" IF such be utilized in a National Health Care system, could also effect a 25% reduction in hours worked then too.
well it doesn’t take much smarts to anticipate a yet further worsening physician shortage in the future under that circumstance , does it?
Now admittedly I have not heard of such a National Health Program , as I refer to above , being under consideration ( has the reader?)and as such I may be holding my concern and boring you readers for no good reason.
However, I fully expect that physician work hours & pay will be a very contentious part of any manouvering designed to effect a National Health Program which would also have the hope of maintaining any good feelings between doctors, patients and government.