Graduate Medical Education Reform
Service Provision Transition Costs
- Jeffrey J. Stoddard, MD;
- David A. Kindig, MD, PhD;
- Donald Libby, PhD
Abstract
Objective. —To analyze the potential strategies and costs of house staff substitution under a reformed system of graduate medical education.
Design. —An economic model using two scenarios for substitution of house staff (residents and fellows): (1) a lower-cost model under which nonphysician providers assume many house staff responsibilities, but additional aspects of their workload are taken over by staff physicians, nurses, and ancillary personnel; and (2) a higher-cost traditional model that relies more heavily on staff physicians to replace house officers.
Setting. —US teaching hospitals.
Main Outcome Measures. —Projected net substitution costs of house staff on a per full-time equivalent basis and aggregate national cost estimates of substitution.
Results. —Net annual house staff substitution costs were estimated to be $58000 and $77000 per replaced full-time equivalent house officer, respectively, under the two scenarios. Assuming elimination of approximately 23200 house staff under a reformed system, total (net) substitution costs to teaching hospitals were estimated at approximately $1.4 billion to $1.8 billion nationally on an annual basis.
Conclusions. —Graduate medical education reform, while likely to result in substantial long-term cost savings, will necessitate transitions in service provision that are likely to generate some new costs in the short term.
(JAMA. 1994;272:53-58)
Footnotes
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Reprint requests to Health Policy Program, University of Wisconsin-Madison Medical School, Second Floor, Bradley Memorial, 1300 University Ave, Madison, WI 53706-1532 (Dr Kindig).
