Graduate Medical Education Reform

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 58, 000 and 77, 000 per replaced full-time equivalent house officer, respectively, under the two scenarios. Assuming elimination of approximately 23, 200 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.