The 'July Effect' in Healthcare

With July almost here, the “July Effect” extends on for months. A not-so-closely held secret, the July Effect has been described for years within the medical profession. It is named as such since newly graduated doctors –– formerly known as interns –– start their hospital duties every July 1. As is common for any professional doing something on their own for the first time, well, let’s just say that mistakes happen. Thus, those of us in medicine warn friends, neighbors, and family to never enter a hospital for anything elective during this month.

Now this assumed phenomenon has been subjected to the rigors of a scientific study. Reporting in the Annals of Internal Medicine, in 2011, Dr. John Young of the University of California, San Francisco, and his team put the oft-quoted assumption to the rigors of scientific scrutiny. They concluded at teaching hospitals responsible for training new doctors, patient death rates increase, while efficiency in patient care decreases during the month of July.

Why is that? Come July, the most experienced residents graduate, leaving behind those who haven't logged as many hours in the clinic or in patient wards. The older residents' departure also coincides with the entry of a new class of freshman residents - new doctors who are taking on the responsibility of patient care for the first time.

Each year in the U.S. the so-called July Effect impacts about 100,000 staff in teaching hospitals. Young notes that such a dramatic shift in personnel rarely occurs in other industries on such a regular basis. His study, which reviewed data from 39 previous studies that tracked health outcomes such as death and complications from medical procedures, found that death rates increased between 8 percent and 34 percent in July.

In other words, investigators have confirmed what we have long suspected. Is this a necessary byproduct of the way we train physicians? Must patients become the collateral damage in the learning process? I think not. Supervision has to be front-loaded, rather than “trials by fire.” One cannot be a medical student one day, and then the next, an independent clinician. Experienced post-graduate trainees, fellows, and attendings, must bear more of the burden early on in the summer months as the newbie learns. Clearly this part of medicine and surgery is more of an art, than a science, and must be individualized.

There will be some quick learners. However, in the final analysis, systems need to be designed more for patient protection than learning by mistakes. The days of “see one, do one, teach one” need to be in the past. All of us in medicine need to help design true quality measures to strike a balance between learning and good patient care.

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