Department of Pediatrics, University of Utah Health, Salt Lake City, Utah.
Department of Pediatrics, University of Utah Health, Salt Lake City, Utah; University of Utah Health, Salt Lake City, Utah.
Acad Pediatr. 2018 Sep-Oct;18(7):837-842. doi: 10.1016/j.acap.2018.05.001. Epub 2018 May 17.
To determine whether residency training represents a net positive or negative cost to academic medical centers, we analyzed the cost of a residency program and clinical productivity of residents and faculty in an outpatient primary care practice with or without residents.
Patient volume and revenue data (Current Procedural Terminology codes) from an academic primary care general pediatric clinic were evaluated for faculty clinics (faculty only) and resident teaching clinics (longitudinal outpatient experience [LOE]) with 1 to 4 residents per faculty. A detailed cost per resident was determined using a departmental financial model that included salary, benefits, faculty and administrative staff effort, nonpersonnel costs, and institutional graduate medical education support.
The LOE clinics had a greater mean number of patient visits (11.6 vs 6.8) than faculty clinics per faculty member. In the LOE clinic, the number of patient visits per clinic was directly proportional to the number of residents per faculty. The cost for each resident was $250 per clinic ($112 per resident, $88 per medical assistant per resident, and $50 per room per resident). When factoring in clinic costs and faculty supervision time, the LOE clinics (average 3.5 residents with 1 supervising faculty) had greater average cost (+$687.00) and revenue (+$319.45) and lower operating margin (revenue minus cost, -$367.55) than the faculty clinics (1 faculty member).
Pediatric resident LOE clinics had a greater average number of patient visits and revenue per faculty member but higher costs and lower operating margins than faculty clinics.
为了确定住院医师培训对学术医疗中心是净成本还是净收益，我们分析了一个门诊初级保健实践中住院医师计划的成本以及住院医师和带教医师的临床生产力，该实践中有或没有住院医师。
评估了一个学术初级保健儿科普通诊所的患者量和收入数据（当前程序术语代码），这些数据来自带教医师诊所（仅带教医师）和住院医师教学诊所（纵向门诊经验 [LOE]），每个带教医师有 1 到 4 名住院医师。使用部门财务模型确定每位住院医师的详细成本，该模型包括工资、福利、带教和行政人员的工作量、非人员成本以及机构研究生医学教育支持。
LOE 诊所每位带教医师的平均患者就诊次数（11.6 次比 6.8 次）多于带教医师诊所。在 LOE 诊所，每个诊所的患者就诊次数与每位带教医师的住院医师人数成正比。每位住院医师的费用为每个诊所 250 美元（每位住院医师 112 美元，每位医疗助理 88 美元，每位住院医师 50 美元）。考虑到诊所成本和带教医师监督时间，LOE 诊所（平均有 3.5 名住院医师和 1 名监督带教医师）的平均成本（增加 687.00 美元）和收入（增加 319.45 美元）更高，运营利润率（收入减去成本，减少 367.55 美元）低于带教医师诊所（1 名带教医师）。
儿科住院医师 LOE 诊所每位带教医师的平均患者就诊次数和收入更高，但成本更高，运营利润率更低。
