Letters Section Editor: Robert M.
Golub, MD, Senior Editor.
In Reply: We agree with Dr Neely that the effect of duty hours reform has been to force hospitals to hire substitutes for house staff (such as hospitalists), and that a comprehensive evaluation of the effects of duty hours reforms must therefore include effects on patients now cared for by these new clinicians, including the cost of their hire. Although these clinicians may be expensive,
especially since they generally earn much more than house staff, it is also possible that their use could substantially decrease hospital costs and more than offset the added salary expenses. Unfortunately,
we do not yet have rigorous studies based on clean experimental designs to assess this possibility. Nevertheless, it is possible that duty hour reform could have paradoxically resulted in cost savings.
Meltzer DO, Arora VM. Resident Duty Hour Reform and Mortality in Hospitalized Patients—Reply. JAMA. 2007;298(24):2865-2867. doi:10.1001/jama.298.24.2866-b