According to the “July effect,” the quality of health care declines in the summer when new medical trainees begin their residencies at training hospitals. While some have thought this phenomenon was more of an urban legend, a systematic review of data from earlier studies has found that the effect indeed seems to be real and that, indeed, “mortality increases and efficiency decreases in hospitals because of year-end changeovers.”
A new study in the Annals of Internal Medicine has found that death rates in hospitals do rise by 8 percent in July when 20 to 30 percent of the more experienced residents at teaching hospitals leave. Further, patients in July have longer hospital stays, undergo more drawn-out medical procedures and end up with higher hospital bills. Says Dr. John Q. Young, the paper’s lead author and the associate program director for the residency training program in psychiatry at the University of California, San Francisco:
“This changeover is dramatic, and it affects everything. It’s like a football team in a high-stakes game, and in the middle of that final drive you bring out four or five players who never played in the pros before and don’t know the playbook, and the players that remained get changed to positions they never played before, and they never practiced together. That’s what happens in July.”
Common sense does make one wonder if it might be possible to have some new residents start their training at other times in the year, or (though I can see how this would probably be immediately considered too complicated) have some residents start at some times and others at others? In a review of the study, Time magazine notes that hospital administrators are indeed “well aware” of the July effect and have taken measures to address it:
Some hospitals ensure that their most experienced physicians are on-call during the summer months, ready to step in and advise or supervise colleagues who might be less confident in their caregiving skills. Other centers conduct in-depth orientation sessions to make sure all new doctors are trained in the proper prescribing and caregiving procedures.
An MSNBC report on the study notes that the July effect should be a reminder to patients that they need to “watch out for themselves.”
With all this said, last summer, we scheduled dental surgery for my son at a local hospital precisely because it was July. My husband and I were both home and able to be present not only for the surgery but for what’s always harder for Charlie, recovering from its effects, from the anesthesia to waking up with his teeth feeling different (something Charlie, who’s autistic and has very limited verbal ability, struggles to relate). Charlie’s dentist was the person performing the surgery but what if there had been complications?
Anthony Youn, MD, a plastic surgeon in the Detroit area, has written about his experience as a new intern in July, and suggests one thing to do should you find yourself in a hospital in July to “treat the new interns with patience and respect” and also “check with your nurse to make sure they know what they’re doing.”
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