title: Graduate medical education reform. Service provision transition costs.
abstract: OBJECTIVE
  To analyze the potential strategies and costs of house staff substitution under a reformed system of graduate medical education.
  
  
  METHODS
  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.
  
  
  METHODS
  US teaching hospitals.
  
  
  METHODS
  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 $58,000 and $77,000 per replaced full-time equivalent house officer, respectively, under the two scenarios. Assuming elimination of approximately 23,200 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.
authors.affiliation: Department of Pediatrics, University of Wisconsin-Madison Medical School 53706-1532.
authors.forename: J J
authors.initials: JJ
authors.lastname: Stoddard
authors.forename: D A
authors.initials: DA
authors.lastname: Kindig
authors.forename: D
authors.initials: D
authors.lastname: Libby
mesh_terms: D004470:Economics, Medical; D004503:Education, Medical, Graduate / Q000639:trends*; D018166:Health Care Reform; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics*; D007396:Internship and Residency / Q000191:economics*; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics; D013038:Specialization; D014481:United States; D000078329:Workforce