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Study Shows Application of Aviation Duty-Hour Restrictions to the U.S. Healthcare System would be Cost-Prohibitive


Restricting resident work hours has been identified as a potential mechanism to improve patient safety. One approach to reform has been to model guidelines and standards after the aviation industry, which are based on two principles: an aircrew’s work schedule should not prevent them from being fully rested at the start of each duty period, and the duration and timing of individual work periods must enable the aircrew to maintain acceptable levels of alertness at all times. This study sought to evaluate the cost and workforce implications of applying aviation duty-hour restrictions to the entire practicing physician workforce. Investigators calculated the work-hours and personnel deficit for U.S. residents and practicing physicians that would be created by adoption of aviation standards.

Findings show that the application of aviation duty-hour restrictions to the U.S. health care system would be cost-prohibitive. Adopting aviation guidelines would create a deficit of 166,835 residents at a cost of approximately $6.45 billion per year. The application of aviation standards for duty-hour restrictions and rest time requirements to actively practicing physicians creates even larger deficits. To correct the work-hours deficit created through widespread adoption of aviation industry standards would require 459,198 physicians at a cost of approximately $80.4 billion per year. Implementing a mandatory retirement age would cost an additional $10.5 billion. Therefore, the authors conclude that the full implementation of aviation work hour standards does not appear to be a viable approach for improving patient safety.

PubMed Logo Payette M, Chatterjee A, and Weeks W. Cost and workforce implications of subjecting all physicians to aviation industry work hour restrictions. American Journal of Surgery June 2009;197(6):820-825.

Dr. Weeks is part of the VA Outcomes Group, White River Junction VAMC.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.