The Value of Surgical Graduate Medical Education (GME) Programs Within An Integrated Health Care System

Lauer, Claire; Shabahang, Mohsen; Restivo, Brian; Lane, Samantha; Hayek, Sarah; Dove, James T.; Ellison, Halle B.; Pica, Erin; Ryer, Evan J.

doi:10.1016/j.jsurg.2019.08.006

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…26 General surgery-specific costs have not yet been published, although Lauer's study of 8 surgical GME programs (including general surgery, otolaryngology, ophthalmology, oralmaxillofacial surgery, urology, pediatric dentistry, and vascular surgery) found an average per trainee cost to be $84,171 per trainee. 27 A study of one academic anesthesia program estimated the annual direct cost of their anesthesia residency (salaries and fringe benefits) to be $1,300,000 and the payments collected to be $2,802,969, with total direct revenue attributable to anesthesiology residents $1,500,000. 28 An estimation of one orthopedic resident's call shifts found that the value of on-call consults performed (not including first assist duties) was twice the amount of DME funds paid to the hospital and 60% of the amount of combined DME and IME payments.…”

Section: Geographic and Specialty Maldistributionmentioning

confidence: 99%

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Graduate medical education funding mechanisms, challenges, and solutions: A narrative review

Whang

Kristo

2021

The American Journal of Surgery

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Background: With increased attention on the federal budget deficit, graduate medical education (GME) funding has in particular been targeted as a potential source of cost reduction. Reduced GME funding can further deteriorate the compensation of physicians during their residency training. Methods: In order to understand the GME funding mechanisms and current challenges, as well as the value of the work accomplished by residents, we searched peer-reviewed, English language studies published between 2000 and 2019.Results: Direct and indirect GME funding is intended to support resident reimbursement and the higher costs associated with supporting a teaching program. However, policy efforts have aimed to reduce federal funding for GME. Furthermore, evidence suggests that residents are inadequately compensated because their salaries do not reflect the number of hours worked and are not comparable to those of other medical staff. Conclusions: Our review suggests that creative solutions are needed to diversify GME funding and improve resident compensation.

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Section: Geographic and Specialty Maldistributionmentioning

confidence: 99%

“…36 In the aforementioned study by Lauer et al, replacing surgery residents with APPs or hospitalists would cost the health system an additional $16,651,281 or $26,119,281 annually, respectively. 27…”

Section: Geographic and Specialty Maldistributionmentioning

confidence: 99%

Graduate medical education funding mechanisms, challenges, and solutions: A narrative review

Whang

Kristo

2021

The American Journal of Surgery

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“…One advantage of creating GME programs in a community health system is that GME programs may reduce health system costs and improve patient outcomes. Numerous studies describe the additional costs in time, throughput, and other productivity metrics that come with involvement of resident and fellow learners [12][13][14][15][16][17][18][19][20][21]. However, these studies narrowly focus on a particular aspect of a hospital profit and loss statement, failing to reflect the full scope of the contribution to the hospital and community within which these programs are situated [9,22,23].…”

Section: Cost Reduction With Improved Patient Outcomesmentioning

confidence: 99%

“…However, these studies narrowly focus on a particular aspect of a hospital profit and loss statement, failing to reflect the full scope of the contribution to the hospital and community within which these programs are situated [9,22,23]. For example, replacing residents with advanced practice providers actually increases cost to an institution with no change in patient outcomes, resulting in net financial loss [9,[21][22][23][24][25][26][27][28]. However, these studies were similarly limited in scope, and it is difficult to separate the costs of providing patient-based education in the setting of patient care, especially given the lack of agreement over the appropriate metrics to use to determine this cost [29].…”

Section: Cost Reduction With Improved Patient Outcomesmentioning

confidence: 99%

Benefits of developing graduate medical education programs in community health systems

Alweis

Donato

Terry

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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The creation of new CMS-funded Graduate Medical Education (GME) cap positions by the Consolidated Appropriations Act 2021 offers a unique opportunity for systems in community and rural settings to develop and expand their training programs. This article provides a review of the evidence behind the value proposition for system administrators to foster the growth of GME in community health systems. The infrastructure needed to accredit GME programs may reduce the cost of care for both the patients and the system through improved patient outcomes and facilitation of system efforts to recognize and mitigate social determinants of health. Residents, fellows and medical students expand the capacity of the current healthcare workforce of a system by providing coverage during healthcare emergencies and staffing services in difficult-to-recruit specialties. Those trainees are the nucleus of succession planning for the current medical staff, can facilitate the creation and expansion of service lines, and may elevate the profile of the system through scholarly work and equity and quality improvement activities. While creating GME programs in a community health system may, at first glance, be perceived as cost-prohibitive, there are robust advantages to a system for their creation.

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“…Inextricable from this discussion is the role residents play in organizational economics, central to which is the complex balance between education and service 21. Although residents are by definition learners in the midst of their specialty training, their skill set allows them to overlap in some duties with higher-paid staff, which is highly cost-effective for the institutions they serve given their low salaries, long hours worked, and external supplemental funding for health care institutions that support Graduate Medical Education 22–27. As a result, there is often no incentive for redundancy in staffing and a historical reliance of health care delivery systems on residents for normal operations 28.…”

Section: Introductionmentioning

confidence: 99%

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

Greenberg¹,

Doherty²,

Cevallos³

et al. 2022

Annals of Surgery

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Objective: To conduct a scoping review of literature on financial implications of surgical resident well-being. Background: Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited. Methods: Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis. Results: Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective. Conclusions: Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area’s importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.

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The Value of Surgical Graduate Medical Education (GME) Programs Within An Integrated Health Care System

Cited by 11 publications

References 14 publications

Graduate medical education funding mechanisms, challenges, and solutions: A narrative review

Graduate medical education funding mechanisms, challenges, and solutions: A narrative review

Benefits of developing graduate medical education programs in community health systems

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

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