Graduate medical education reform. Service provision transition costs.
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.
Stoddard
J J
JJ
Department of Pediatrics, University of Wisconsin-Madison Medical School 53706-1532.
Kindig
D A
DA
Libby
D
D
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