title: Productivity vs. training in primary care: analysis of hospitals and health centers in New York City.
abstract: This paper examines the indirect costs of primary care residency in terms of ambulatory care site productivity and the influence of graduate medical education (GME) subsidies on the employment of primary care residents. Using a sample of hospitals and health centers in New York City (NYC), we find that most facilities employ significantly more primary care residents relative to nonresident primary care physicians than would be dictated by cost-minimizing behavior in the production of primary care. We also find evidence that New York's GME subsidy encourages the "overemployment" of residents, while the Medicare GME subsidy does not. We conclude that the trade-off between productivity and teaching is more serious in primary care than in inpatient settings, and that facilities heavily involved in ambulatory care teaching will be at a competitive disadvantage if GME subsidies are not targeted specifically for primary care.
authors.affiliation: United Hospital Fund of New York, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: DeLia
authors.forename: Joel C
authors.initials: JC
authors.lastname: Cantor
authors.forename: Elaine
authors.initials: E
authors.lastname: Duck
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics*; D004503:Education, Medical, Graduate / Q000191:economics* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics / Q000193:education* / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000706:statistics & numerical data; D006278:Medicare / Q000331:legislation & jurisprudence; D017059:Models, Econometric; D009519:New York City; D009819:Office Visits / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D013663:Teaching / Q000191:economics; D014146:Training Support; D000078329:Workforce