Cost and workforce implications of subjecting all physicians to aviation industry work-hour restrictions

BACKGROUND: Efforts to improve patient safety have attempted to incorporate aviation industry safety standards. We sought to evaluate the cost and workforce implications of applying aviation duty-hour restrictions to the entire practicing physician workforce. METHODS: The work hours and personnel deficit for United States residents and practicing physicians that Would be created by the adoption of aviation standards were calculated. RESULTS: Application of aviation standards to the resident workforce creates an estimated annual cost of $6.5 billion, requiring a 174% increase in the number of residents to meet the deficit. Its application to practicing physicians creates an additional annual cost of $80.4 billion, requiring a 71% increase in the physician workforce. Adding in the aviation industry's mandatory retirement age (65 years) increases annual costs by $10.5 billion. The cost per life-year saved would be $1,035,227. CONCLUSIONS: Application of aviation duty-hour restrictions to the United States health care system would be prohibitively costly. Alternate approaches for improving patient safety are warranted. (C) 2009 Elsevier Inc. All rights reserved.