title: Strategic impact of a new academic endocrine surgery program.
abstract: BACKGROUND
  A minority of medical centers possess a dedicated endocrine surgery program. Here we assess the short-term impact of a new endocrine surgery program on institutional case volumes and financial endpoints.
  
  
  METHODS
  We studied all endocrine procedures performed over a 5-year period spanning the inception of the endocrine surgery program at UCLA. Institutional and state-level data on patient geographic origin, discharges for endocrine diagnosis-related groups (DRGs), and hospital-side charges and costs were examined.
  
  
  RESULTS
  Total endocrine case volume increased 112% (264 to 559 cases annually) over the study period. The relative increase was greater for parathyroid (56 to 196, 250%, P < 0.0001) and adrenal (11 to 31, 181%, P = 0.06) procedures compared to thyroid procedures (317 to 442, 39%). The endocrine case volume of nonspecialist surgeons remained stable over the study period. Growth in referrals arose from previously unrepresented zip codes and was associated with an increase in the mean distance traveled for care (2006, 44 miles vs. 2009, 92 miles, P < 0.01). In each DRG, UCLA attained the top market position within one year of the program's inception, corresponding to an overall 27% increase in regional market share. Total hospital charges for endocrine DRGs rose 161% to $14.7 million annually, while the cost of parathyroid surgery fell 34% (P < 0.001).
  
  
  CONCLUSIONS
  The establishment of an academic endocrine surgery program can cause fundamental shifts in referral patterns within a competitive, densely populated metropolitan environment. Hospitals should consider the inclusion of an endocrine surgery program in strategic planning initiatives.
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. jwiseman@mednet.ucla.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Wiseman
authors.forename: Philip H G
authors.initials: PH
authors.lastname: Ituarte
authors.forename: Roy S
authors.initials: RS
authors.lastname: Hwang
authors.forename: Ilan
authors.initials: I
authors.lastname: Safir
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Pasternak
authors.forename: Karen
authors.initials: K
authors.lastname: Van Nuys
authors.forename: Michael W
authors.initials: MW
authors.lastname: Yeh
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D013507:Endocrine Surgical Procedures / Q000706:statistics & numerical data*; D004700:Endocrine System Diseases / Q000601:surgery*; D006801:Humans