While the study had a number of scientific limitations; the two most significant were: 1) although the response rate of interns that volunteered to participate was 80%, those that did participate may not have been representative; and 2) the case-crossover analysis cannot account for the contribution of within-person factors that may have been co-variables with exposure status.
Evaluation
As a result of the related research, hospitals will be using medical resident interns as a means of making up for the lack of doctors caused by financing concerns. The redistribution of medical interns was expected to be completed before the next residency training year starts July 1, 2005, however, it remains currently underway. The Association of American Medical Colleges has stated that the health care system would be better off if the cap were lifted so hospitals could respond to the needs of their communities, such as adding a new cardiology program or expanding emergency medicine. However, as Croasdale (2004) indicates, it is unclear though, what this would cost. The federal government, through CMS, spends roughly $8 billion a year on graduate medical education or $80,000 per resident (Croasdale, 2004). These factors affect small rural hospitals even more, since physicians are affluent and in short supply, they tend to locate where they want to live.
An example of how this directly affects my clinical setting, a small rural 200 bed facility, can be described by the following example. Jackson Hospital, a 120-bed hospital in Marianna, Florida, located in a small town of 6,200 is in need of an urologist, a radiologist, an ear, nose and throat specialist and a gynecologist. According to the hospital administrator Charles Ellis, "it's supply and demand, and it's hard to get doctors here (Cauchon, 2005)." Additional research supports the conclusion that particularly scarce are old-fashioned specialists, such as general surgeons, radiologists, anesthesiologists, that have a wide range of duties. For example, Jackson Hospital has one radiologist who does the work of two or three doctors, working 15 to 18 hours a day.
Furthermore, new radiologists are not very interested in traditional radiology, and prefer cutting-edge radiology using catheters to treat cancer, blood clots and other problems, which is more lucrative and have predictable hours (Cauchon, 2005). According to Croasdale (2004), the rules CMS has set up for the audit will unfairly penalize some hospitals; if Medicare's administrative requirements...
faces at least a decade of severe physician shortages, a desperate situation that must be resolved now, since it takes a long time to train a doctor. This has caused a lack of needed doctors in smaller facilities, and the federal programs responsible for paying and subsidizing medical positions for students are in a financial state of crisis. As a result of the financial crisis, medical student interns must work longer hours, at a detriment to their safety and the safety of others. The safety of others that is placed at risk involves the general public as well as the patients that the over-tired medical student is supporting or treating. In an effort to address the uneven distribution of physicians in the United States, the Centers for Medicare & Medicaid Services, which heavily subsidizes graduate medical education, is tracking down unused resident positions and reallocating them to hospitals it deems the most in need of more physicians.
However, a review of the literature indicates that this may not be a permanent solution, as it causes additional problems to surface. For example, more physicians may drive up the cost of medical care, not make it cheaper and more accessible. This will occur by physicians ordering more tests, more procedures and more drugs, without improving the public's health. Thus, without some necessary reforms, the financial state of the medical profession remains threatened.
Bibliography
Barger, L., Cade, E., Ayas, N., Cronin, J., Rosner, B., Speizer, F. & Czeisler, C. (2005).
Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns. NEJM
Cauchon, D. (2004). Medical Miscalculation Creates Doctor Shortage. USA Today,
Croasdale, M. (2004). Residency Slots Reallocated to Relieve Doctor Shortages.
Retrieved April 23, 2007, at http://www.ama-ass.org.
Ellenbogen, J. (2005). Cognitive benefits of sleep and their loss due to sleep deprivation.
Neurology 64, E25-E27.
Fletcher, K., Underwood, W., Davis, S., Mangrulkar, R. Mcmahon, L. & saint, S. (2005).
Effects of Work-Hour Reduction on Residents' Lives: A Systematic Review. JAMA
294, 1025-1033.
Landrigan, C., Barger, L., Cade, B. Ayas, N. & Czeisler,…
