Darrell Kirch, president and chief executive officer of the Association of American Medical Colleges, in his podcast interview with Modern Healthcare Editor David Burda, addressed issues of long hours, fatigue and harm to patients by overworked and overburdened house staff (interns and residents).
He did not admit that house staff are often asked to work long hours for the benefit of hospitals bottom lines. Heres how it works:
Hospital A signs contracts with governmental or nongovernmental providers. Managed Care Plan X offers a contract with 100,000 potential patients, i.e., 100,000 subscribers, many of whom will become patients. Hospital A knows that it has enough house staff to cover these patients. The contract is signed. Everybody is happy.
Managed Care Plan Y then offers another 75,000 subscribers. Hospital A likes the remuneration and accepts the offer even though the hospital knows it doesnt have enough house staff to cover these additional patients. Nonetheless, this contract is also signed. But not everyone is happy this time.
The hospital is now obliged to make house staff work longer and harder. When the house staff doctors complain that they are being overworked and underpaid, the hospital tells them that theyre just students. The long hours, the hospital CEO intones, is part of the training. What unmitigated gall! The long hours are part of the hospitals money-acquisition policy. Along the way, if beleaguered house staff can stay awake and not kill anyone, theres education, also.
The tailoring of duty hours that this CEO wants is a thinly disguised ruse to put profits before patients. The flexibility this CEO wants is a license to restore indentured servitude to a system that is already broken. We should say No!
Robert L. Weinmann, M.D.Formerly president of Union of American Physicians and Dentists, 1989-2006San Jose, Calif.
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