Hospital Manager

Twice a year, physicians come together for an exhibit of democracy at its best through the AMA House of Delegates meeting. Since 1901, physicians and medical student from every state and every qualifying medical specialty debate and vote on behalf of their peers during discussions that shape the AMA’s health care agenda. The work they do is intense, the opinions and debate are passionate. This representational-style system makes the AMA, without question, the umbrella organization of American medicine.

This week, the AMA House of Delegates met in Houston and again demonstrated its unique ability to bring together voices from across the profession to create a national consensus of physicians and medical students on health reform. I was honored to be a part of the civil debate on health reform at the nation’s broadest, most inclusive assembly of physicians and medical students.

Physicians at the meeting passionately defended their positions and then voted on a course forward for the AMA. At times there was fierce debate, but ultimately there was a clear final product – a shared vision on how to help physicians help patients.

The physician prescription for reform that emerged from this meeting reaffirmed the AMA’s commitment to health system reform. As the country’s foremost organization of physicians – for physicians – the AMA must continue in its role at the center of the health reform process.

Limiting surgical residents’ work hours has compromised both surgical education and patient safety, according to an analysis concluding that an 80-hour work week isn’t enough.

Surgeons dont receive enough training when resident work hours are capped The maximum 80-work week imposed in the U.S. for residents is too little to provide mastery in surgery, Gretchen Purcell Jackson, MD, PhD, and John L. Tarpley, MD, both of Vanderbilt Children’s Hospital, wrote in online in the British Medical Journal.

Although the cap on working hours was designed to enhance patient safety by keeping exhausted residents away from operating tables and other aspects of patient care, rates of surgical complications and reinterventions actually climbed after the rules were imposed, they said.

Jackson and Tarpley recommended more flexibility in duty-hour limits for surgical residents in particular.

“Surgical disciplines are unique in that surgeons must not only acquire medical knowledge but also develop the manual dexterity and, sometimes, the strength and endurance to perform procedures,” they said. “There probably isn’t a shortcut for learning surgery.”

The 80-hour week limitation in the U.S. regulations, instituted in 2003 across medical disciplines, is already much longer than 48-hour limit imposed by the European Working Time Directive for trainees in 2009 and the 37-hour week instituted by Denmark.

But even the 80-hour U.S. limit, twice as long as the standard work week in most industries, has been met by opposition from groups including the American College of Surgeons who say it’s not tough enough.

With health reform looking more likely, it’s worth looking at the Massachusetts model to predict what’s going to happen nationwide.

I’ve written several times that the lack of primary care access will simply shift newly insured patients to already crowded emergency departments, where care is exponentially more expensive. And in the end, it is that lack of spending control that will make the costs of universal coverage unsustainable.

According to recent data, well, we’re pretty much on that path.

In an article from American Medical News, a poll of Massachusetts emergency physicians stated that, “42% of the 138 physicians surveyed said emergency care had ’somewhat increased’ since the reforms took effect, and 22% said such care had ’significantly increased.’”

Furthermore, many of those who seek emergency care already have insurance, disproving the myth that the uninsured are primarily responsible for filling up ERs.

There’s little question that providing universal coverage is a laudable goal, but it cannot be done without consequence. With little relief for ER crowding being discussed, a scenario where the majority of Americans have coverage, but cannot access care, is going to be likely possibility.