Impact of the Libby Zion case on graduate medical education in internal medicine.
Residency training in New York State was substantially altered by the Libby Zion case. Work-hour limitations and augmented supervisory requirements changed the patterns of training--particularly in internal medicine--but with uncertain impacts on the quality of education and patient care. In this historical analysis, we review another major effect of the case: a substantial augmentation of the number of trainees. The need to maintain adequate inpatient staffing--within the ground rules of the Residency Review Committee, and in consideration of the reimbursement formulae and financial climate of New York State--conspired to promote substantial residency program expansion. Similar forces contributed to a national trend to increase the number of trainees. The history, cost and impact of these personnel changes are reviewed.
Brensilver
J M
JM
Sound Shore Medical Center of Westchester, New Rochelle, NY 10802, USA.
Smith
L
L
Lyttle
C S
CS
D005069:Evaluation Studies as Topic; D005161:Facility Regulation and Control; D006784:Hospitals, Teaching / Q000331:legislation & jurisprudence*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000191:economics / Q000331:legislation & jurisprudence*; D009518:New York; D009519:New York City; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence / Q000592:standards; D011787:Quality of Health Care; D014940:Work Schedule Tolerance; D000078329:Workforce; D016526:Workload / Q000331:legislation & jurisprudence*; D017132:Workplace