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.

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.