January 30, 2013
When the Affordable Care Act is fully implemented, 32 million formerly-uninsured patients are expected to enter the health system. The influx has many experts worried about a physician shortage as doctors are not being added to the system at the same rate.
While this could translate into doctors accepting fewer patients in offices, it could also mean crowded hospitals and overworked staff. A new survey from JAMA Internal Medicine sheds light on the troubling consequences when hospital physicians have too many patients to treat.
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According to the survey of over 500 hospital physicians, respondents estimated they can safely see 15 patients per shift, but 40 percent of physicians reported that their typical number of patients exceeded that level.
The excessive workload had many negative effects, including preventing the physicians from fully discussing treatment options, delaying patient admissions or discharges, unnecessary tests or procedures, poor patient satisfaction – and 12 percent said that being overworked likely contributed to complications or death.
“As perceived by physicians, workload issues have the significant potential to do harm and decrease quality,” said Dr. Henry Michtalik, the study's lead author and a physician at Johns Hopkins, in a press release. “It is the elephant in the room that cannot be ignored. We have to find that balance between safety, quality and efficiency.”
Though work-hour restrictions are required for medical interns during residency, a 2008 study found that 87 percent of interns in three hospitals reported working past their shift limit. Alternatively, full-time attending physicians have no work limits, and are often forced to pick up the slack after a resident physician leaves. “With increased economic pressures on hospitals and limitations on resident physician work hours, attending physician workload has likely increased,” write the authors in the study.
The Affordable Care Act could further strain workloads as hospitals look to cut costs and manage the influx of new patients. “Society needs to reduce health care costs, but do so wisely…” the authors write. “Hospitals need to create standards for safe levels of work… Excessively increasing the workload may lead to sub-optimal care and less direct patient care time, which may paradoxically increase, rather than decrease, costs.”