Jj. Stoddard et al., GRADUATE MEDICAL-EDUCATION REFORM - SERVICE PROVISION TRANSITION COSTS, JAMA, the journal of the American Medical Association, 272(1), 1994, pp. 53-58
Objective.-To analyze the potential strategies and costs of house staf
f substitution under a reformed system of graduate medical education.
Design.-An economic model using two scenarios for substitution of hous
e staff (residents and fellows): (1) a lower-cost model under which no
nphysician providers assume many house staff responsibilities, but add
itional aspects of their workload are taken over by staff physicians,
nurses, and ancillary personnel; and (2) a higher-cost traditional mod
el that relies more heavily on staff physicians to replace house offic
ers. Setting.-US teaching hospitals. Main Outcome Measures.-Projected
net substitution costs of house staff on a per full-time equivalent ba
sis and aggregate national cost estimates of substitution. Results.-Ne
t annual house staff substitution costs were estimated to be $58 000 a
nd $77 000 per replaced full-time equivalent house officer, respective
ly, under the two scenarios. Assuming elimination of approximately 23
200 house staff under a reformed system, total (net) substitution cost
s to teaching hospitals were estimated at approximately $1.4 billion t
o $1.8 billion nationally on an annual basis. Conclusions.-Graduate me
dical education reform, while likely to result in substantial long-ter
m cost savings, will necessitate transitions in service provision that
are likely to generate some new costs in the short term.