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July 6, 1994

Graduate Medical Education ReformService Provision Transition Costs

Author Affiliations

From the Departments of Pediatrics (Dr Stoddard) and Preventive Medicine (Dr Libby) and Health Policy Program (Dr Kindig), University of Wisconsin-Madison Medical School, and Meriter Hospital, Madison (Dr Stoddard).

JAMA. 1994;272(1):53-58. doi:10.1001/jama.1994.03520010065034

Objective.  —To analyze the potential strategies and costs of house staff substitution under a reformed system of graduate medical education.

Design.  —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.

Setting.  —US teaching hospitals.

Main Outcome Measures.  —Projected net substitution costs of house staff on a per full-time equivalent basis and aggregate national cost estimates of substitution.

Results.  —Net annual house staff substitution costs were estimated to be $58000 and $77000 per replaced full-time equivalent house officer, respectively, under the two scenarios. Assuming elimination of approximately 23200 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.

Conclusions.  —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.(JAMA. 1994;272:53-58)