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Value of residents’ on-call work exceeds medical education funding received
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There was a significantly higher value of on-call work performed by orthopedic residents than the amount received by hospitals for that work through direct medical education payments, study results showed.
“The number one take-home point is [this study] establishes, at least, a baseline value that taxpayers are getting for their money as far as orthopedic residents,” James P. Davies, MD, of the department of orthopedic surgery at Palmetto Health University of South Carolina, told Orthopedics Today.
Davies and his colleagues prospectively collected on-call consults of orthopedic residents at four institutions over a 90-day period when the resident was the initial contact for emergency department and inpatient consultations. Consults were assigned a CPT code based on the procedure performed and were converted into work relative value units (wRVUs) using the 2014 Medicare CPT to wRVU Crosswalk program.
Researchers multiplied the wRVUs by the 2014 Medicare rate of $35.8228 per RVU to calculate the monetary value of resident on-call work.
“The dollar amount per consult was the primary outcome and the average salary of each residency program regionally was also looked at to compare this to the dollars generated by the orthopedic resident,” Davies said
More than 2,600 consults occurred during the 90-day period, which generated more than 9,000 RVUs. Of the consults, 60% were Medicaid self-pay; 40% were private; and 21% were Medicare, according to Davies.
“As far as the average 90-day value per center generated, this was almost $82,000, the range [was] from $65,000 to almost $100,000 generated total, with the average monetary annualized value almost bordering $325,000, which is substantial,” he said.
Compared with regional funds provided by graduate medical education through Medicare, “this averaged 36% of the yearly resident salaries of every single resident across all four participating programs only looking at junior residents seeing consults,” Davies said.
Davies told Orthopedics Today research should now include a longer time span of consults and include other subspecialties, specifically those that utilize non-procedural services, to find the value among those residents.
“This is only a good study that is applicable to procedural-based specialties, like orthopedics, where we are doing CPT codes. It may be a lot less applicable to services like primary care, family practice, internal medicine, where they bill more for history of physical examinations rather than billable procedural services,” he said. “The next order of magnitude of study is to then take subspecialties that are reimbursed by that method and look at how much value are nonprocedural-based residents adding and what is their value.” – by Casey Tingle
- Reference:
- Jackson JB 3rd, et al. J Grad Med Educ. 2018;doi:10.4300/JGME-D-17-00277.1.
- For more information:
- James P. Davies, MD, can be reached at 3555 Harden St. Ext., 15 Medical Park, Suite 202, Columbia, SC 29203; email: james.davies@palmettohealth.org.
Disclosure: Davies reports no relevant financial disclosures.
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Michael J. Gardner, MD
The authors have performed an interesting study. They tracked resident consults and ward or ER procedures done on nights or weekends at four institutions over 3 months. They used the consult sheets to determine evaluation and management (E&M) and CPT codes to estimate the dollar value of the residents billable work based on CMS reimbursement per wRVUs. They made the assumptions, for the sake of rough comparison, this work was not billed by an attending. Of course, there were likely instances where the attending supervised a procedure on a weekend or saw the patient in the morning and billed an E&M code. But, despite the inability to precisely determine the actual unbilled codes, the discrepancy between the estimated value (unbilled work) the residents provide and the current graduate medical education (GME) funding is so large that there is a clear message. Currently, resident work value provided to a hospital far outweighs their CMS funding. It is strongly hoped policy makers take into account this aspect of residency training when considering budget and funding decisions. Of course, while all of this discussion focuses on finances, it is also hoped these same policy makers recognize the importance of GME and do what is necessary to support the programs that are tasked with training our future physicians.
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