The study by Dr Mitchell and colleagues1 suggests that replacing residents with alternative providers to meet resident duty-hour requirements would increase expenses at teaching hospitals. Although this forecast incorporates a variety of work-flow variables, this model ignores possible costs avoided by improvements in patient safety. A primary goal of the Accreditation Council for Graduate Medical Education (ACGME) resident duty guidelines was to improve patient safety based on evidence of increased medical errors by sleep-deprived residents. Mitchell and colleagues concede that the model does not account for patient safety concerns but cite a failure to account for increased faculty workload as the most concerning because of the implications for teaching and research duties. We believe, however, that the patient safety concerns represent an equally important concern because preventable medical errors have significant cost implications.
Venkatesh A, Noskin G. Making Better Cents of Future Teaching Hospital Costs. Arch Surg. 2007;142(12):1226. doi:10.1001/archsurg.142.12.1226-a