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- Title
Graduate medical education reform. Service provision transition costs.
- Authors
Stoddard, J J; Kindig, D A; Libby, D
- Abstract
<bold>Objective: </bold>To analyze the potential strategies and costs of house staff substitution under a reformed system of graduate medical education.<bold>Design: </bold>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.<bold>Setting: </bold>US teaching hospitals.<bold>Main Outcome Measures: </bold>Projected net substitution costs of house staff on a per full-time equivalent basis and aggregate national cost estimates of substitution.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
UNITED States; WORKING hours; PRIMARY health care; WORKING hour statistics; ACADEMIC medical centers; COMPARATIVE studies; ECONOMICS; HEALTH care reform; HOSPITAL costs; INTERNSHIP programs; RESEARCH methodology; MEDICAL cooperation; MEDICAL education; MEDICAL specialties &; specialists; RESEARCH; EVALUATION research
- Publication
JAMA: Journal of the American Medical Association, 1994, Vol 272, Issue 1, p53
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.272.1.53