Is There a Return on a Children’s Hospital’s Investment in a Pediatric Residency’s Community Health Track? A Cost Analysis

  • Cara Lichtenstein
  • Denice Cora-Bramble
  • Mary Ottolini
  • Dewesh Agrawal
Original Paper

Abstract

Academic Medical Centers incur significant expenses associated with training residents and caring for underserved populations. No previous studies have analyzed hospital-level graduate medical education economics for pediatric residency training. Using data from the 2010–2011 academic year, we quantified total direct costs per year for training 12 community health track (CHT) residents. Utilizing sensitivity analyses, we estimated revenues generated by residents in inpatient and outpatient settings. The total yearly direct cost of training 12 CHT residents was $922,640 including salaries, benefits, and administrative costs. The estimated additional yearly inpatient net revenue from attending-resident clinical teams compared to attendingonly service was $109,452. For primary care clinics, the estimated yearly revenue differential of resident-preceptor teams was $455,940, compared to attending-only clinics. The replacement cost of 12 CHT residents with advanced practitioners was $457,596 per year.This study suggests there is positive return on a children’s hospital’s investment in a CHT.

Keywords

Residency training Return on investment Community health track Children’s Hospitals Graduate Medical Education (CHGME) Funding 

References

  1. 1.
    Committee on Pediatric Workforce. (2008) Financing graduate medical education to meet the needs if children and the future pediatrician workforce. Pediatrics 121, 855–861.CrossRefGoogle Scholar
  2. 2.
    Grover, A., Slavin, P. L., & Willson, P. (2014). The economics of academic medical centers. New England Journal of Medicine, 370, 2360–2362.CrossRefPubMedGoogle Scholar
  3. 3.
    Children’s Hospital Association. About Children’s Hospitals. Retrieved from: https://www.childrenshospitals.org/About-Us/About-Childrens-Hospitals.
  4. 4.
    Nuckols, T. K., Bhattacharya, J., Wolman, D. M., Ulmer, C., & Escarce, J. J. (2009). Cost implications of reduced work hours and workloads for resident physicians. New England Journal of Medicine, 360, 2202–2215.CrossRefPubMedGoogle Scholar
  5. 5.
    Romano, P. S., & Volpp, K. (2012). The ACGME’s 2011 changes to resident duty hours: Are they an unfunded mandate on teaching hospitals? Journal of general internal medicine: official journal of the Society for Research and Education in Primary Care Internal Medicine, 27, 136–138.CrossRefGoogle Scholar
  6. 6.
    APPD Board of Directors (2009) APPD position statement in response to the IOM recommendations on resident duty hours. Released April 30, 1–12.Google Scholar
  7. 7.
    Summary of coverage provisions in the patient protection and afffordable care act. (Accessed 4 Jan 2013, at http://www.kff.org/healthreform/upload/8023-R.pdf.).
  8. 8.
    Dill, M. J., & Salsberg, E. S. (2008) Center for Workforce Studies. The complexities of physician supply and demand: Projections through 2025. http://www.innovationlabs.com/pa_future/1/background_docs/AAMC%20Complexities%20of%20physician%20demand,%202008.pdf: American Association of Meidcal Colleges.
  9. 9.
    Petterson, S. M., Liaw, W. R., Phillips, R. L., Rabin, D. L., Meyers, D. S., & Bazemore, A. W. (2012). Projecting US primary care physician workforce needs: 2010–2025. Annals of Family Medicine, 10, 503–509.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Stimpson, J., Li, T., Shiyanbola, O., & Jackson, J. (2014). Financial sustainability of academic health centers: Identifying challenges and strategic responses. Academic Medicine, 89, 853–857.CrossRefPubMedGoogle Scholar
  11. 11.
    Franzini, L., Monteiro, F. M., Fowler, G. C., & Low, M. D. (1999). A cost construction model to assess the cost of a family practice residency program. Family Medicine, 31, 159–170.PubMedGoogle Scholar
  12. 12.
    Casey, L., Gillanders, W. R., & Oprandi, A. (1995). Economic analysis of family practice residency programs: A report for the Northeast Ohio Network. Family Medicine, 27, 7.Google Scholar
  13. 13.
    Zeidel, M. L., Kroboth, F., McDermot, S., et al. (2005). Estimating the cost to departments of medicine of training residents and fellows: A collaborative analysis. The American Journal of Medicine, 118, 557–564.CrossRefPubMedGoogle Scholar
  14. 14.
    Chandra, A., Khullar, D., & Wilensky, G. R. (2014). The Economics of Graduate Medical Education. New England Journal of Medicine, 370, 2357–2360.CrossRefPubMedGoogle Scholar
  15. 15.
    Iannuzzi, M. C., Iannuzzi, J. C., Holtsbery, A., Wright, S. M., & Knohl, S. J. (2015). Comparing hospitalist-midlevel practitioner team performance on length of stay and direct patient care cost. Journal of Graduate Medical Education, 7, 65–69.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Morris, C. G., Johnson, D., Kim, S., & Chen, F. M. (2008). Training family medicine residents in community health centers: a health workforce solution. Family Medicine, 40, 271–276.PubMedGoogle Scholar
  17. 17.
    Jones, T. F., Culpepper, L., & Shea, C. (1995). Analysis of the cost of training residents in a community health center. Academic Medicine, 70, 523–531.CrossRefPubMedGoogle Scholar
  18. 18.
    Jones, T. F. (1997). The cost of outpatient training of residents in a community health center. Family Medicine, 29, 347–352.PubMedGoogle Scholar
  19. 19.
    Adams, M., & Eisenberg, J. M. (1997). What is the cost of ambulatory education. Journal of General Internal Medicine, 12, s104–s10.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nasca, T. J., Veloski, J. J., Monnier, J. A., et al. (2001). Minimum instructional and program specific administrative costs of educating residents in internal medicine. Archives of internal medicine, 161, 760–766.CrossRefPubMedGoogle Scholar
  21. 21.
    Cora-Bramble, D., Joseph, J., Jain, S., Huang, Z. J., Gaughan-Chaplain, M., & Batshaw, M. (2006). A cross-cultural pediatric residency program merger. Academic medicine: journal of the Association of American Medical Colleges, 81, 1108–1114.CrossRefGoogle Scholar
  22. 22.
    Morris, C. G., & Chen, F. M. (2009). Training residents in community health centers: Facilitators and barriers. Annals of Family Medicine, 7, 488–494.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of PediatricsGeorge Washington University School of Medicine and Health SciencesWashingtonUSA
  2. 2.Pediatric Residency ProgramChildren’s National Health SystemWashingtonUSA
  3. 3.Diana L. and Stephen A. Goldberg Center for Community Pediatric HealthChildren’s National Health SystemWashingtonUSA
  4. 4.Medical EducationChildren’s National Health SystemWashingtonUSA
  5. 5.Emergency Medicine & Trauma ServicesChildren’s National Health SystemWashingtonUSA

Personalised recommendations