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MCV Weighs Costs of Cutting Hours

Studies have shown that quality of care suffers when residents work extremely long shifts or get too few days off. Thus in September, the national Accreditation Council for Graduate Medical Education adopted standards that require residents to work no more than 80 hours per week, averaged over a two-week period, and to limit on-call shifts.

Making the change will not be easy, says Mary Alice O'Donnell, director of graduate medical education at MCV.

Like all teaching hospitals, MCV depends heavily on its 500 residents. "The residents are an incredible resource," O'Donnell says. "But if we decrease their workload, who's going to do the work?"

MCV administrators see higher expenses as inevitable, she says, but have yet to estimate what the change will cost the hospital and its patients. "It's a risk," she says. "But it's the right thing to do."

Of MCV's 59 residency programs, 41 already comply with the new standards, O'Donnell says. Faculty and residents in the remaining 18 are trying to figure out how best to compensate for the reduced work hours, which take effect by July.

MCV is trying out a system that has residents work as teams in 12-hour shifts to preserve a continuum of care. Residents could also "cross-cover" for two similar specialties during their shifts, she says. One might work in both the well-baby nursery and the general pediatric floor at the same time, for example.

The directors of each residency program are meeting with students and faculty to determine how best to schedule hours to make sure MCV is adequately staffed during the transition, O'Donnell says.

The change has been a long time coming. Not long ago, O'Donnell says, she was watching the TV drama "MDs" and "this little intern was whining that she'd been up for 35 hours. I was like, 'Hmm. Not like the old days.'"

— Melissa Scott Sinclair

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