Assessing the Value of Work Done by an Orthopedic Resident During Call

Abstract

Introduction Resident physicians are a critical part of the medical workforce. They are important to the care for medically underserved patients and improve access to care by working at academic medical centers with a high volume of these patients. Most resident education is funded by the Medicare system, with national funding totaling $9.5 billion in 2010. 1 To reduce the federal deficit, Medicare funding of graduate medical education (GME) has been targeted for cuts. 1 Simultaneously, numerous reports project coming physician shortages and decreased resident duty hours despite increased demand with the Affordable Care Act. 1 In this context, it is important to demonstrate the value residents provide to the health care system during training to justify preservation or even increases in funding for GME. Studies that quantify the amount and type of work done by residents are difficult to perform and interpret. Some have attempted to calculate the amount of work lost under duty hour reductions, resulting in estimates of as much as $1.6 billion/y. 2,3 Two studies 4,5 tracked the types of duties that residents perform on call, whereas 2 others 6,7 examined theoretical relative value unit (RVU) generation by residents and fellows. To date, no study, to our knowledge, has measured the number of RVUs generated by a single orthopedic resident while on call. The purpose of our study was to quantify the amount and type of work performed by a junior orthopedic surgery resident during a 2-year experience of in-hospital call at a level-1 trauma center, and its calculated Medicare value. In our hospital, on-call work outside the operating room is performed without the attending physician being physically present, and thus, no bills are submitted for the care provided by the on-call resident. We compare the value of that work to the funding received from Medicare to support GME to determine whether the government investment in our orthopedic residency program is cost-effective. Funding: The authors report no external funding source for this study. Abstract Background Medicare funding for graduate medical education may be cut in the next federal budget.