title: When is a "free" registrar in clinic not free?
abstract: OBJECTIVE
  To investigate whether using registrars (doctors undergoing higher specialist training, whose salary is reimbursed) rather than consultants in outpatient clinics saves money
  
  
  METHODS
  Development of a formula calculating the economic breakeven point and application to retrospective audit data from 273 outpatient consultations.
  
  
  METHODS
  General cardiology outpatient clinic in a secondary and tertiary referral NHS hospital. Outcomes Difference in probability of a registrar and a consultant making a diagnostic decision that completes a clinical episode. Use of UK costings for consultant salaries and outpatient attendances to determine the economic breakeven point.
  
  
  RESULTS
  The formula showed that if a registrar's episode completing probability is 12 percentage points lower than that of a consultant, then using a registrar costs the hospital more. Real life data showed that episode completion probabilities are 43 percentage points lower for registrars than for consultants (26% versus 69%, 95% CI 32% to 54%, P<0.0001).
  
  
  CONCLUSIONS
  It is wrong to assume that external reimbursement of registrar salaries makes them a money saving option for staffing clinics. The apparent service role of a registrar can be a disservice.
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London W2 1LA, UK. amrit.lota@doctors.org.uk
authors.forename: Amrit S
authors.initials: AS
authors.lastname: Lota
authors.forename: Charlotte H
authors.initials: CH
authors.lastname: Manisty
authors.forename: Richard
authors.initials: R
authors.lastname: Sutton
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
mesh_terms: D016507:Cardiology Service, Hospital / Q000191:economics*; D003253:Consultants; D017050:Episode of Care; D017048:Health Care Costs; D006801:Humans; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000191:economics* / Q000193:education; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D013222:State Medicine / Q000191:economics; D006113:United Kingdom; D000078329:Workforce