House staff supervision and working hours. Implications of regulatory change in New York State

In July 1989, New York State adopted new rules that limit the hours worked by residents and mandate continuous, on-site supervision of junior residents. In addition, all New York hospitals must provide 24-hour coverage for intravenous, phlebotomy, and messenger/transporter services. This article examines the impact of New York's landmark changes on hospital staffing, graduate medical education, the demand for ancillary personnel, and hospital expenditures. Based on a statewide survey, the results indicate that implementation of these rules would require hospitals to hire an additional 5358 full-time equivalent personnel at a yearly cost that would exceed $358 million. The broader implications of these rules on financing graduate training are also explored.