The economic value of an on-call neurosurgical resident physician

View More View Less
  • 1 Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis;
  • 2 Semmes Murphey, Memphis; and
  • 3 Le Bonheur Children’s Hospital, Memphis, Tennessee
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents.

METHODS

A personal call log kept by a single junior neurosurgical resident over a 2-year period was used to obtain the total number of consultations, admissions, and procedures. Current Procedural Terminology (CPT) codes were used to estimate the resident’s on-call economic value.

RESULTS

A single on-call neurosurgical resident at the authors’ institution produced 8172 work relative value units (wRVUs) over the study period from indirectly and directly supervised activities. Indirectly supervised procedures produced 7052 wRVUs, and directly supervised activities using the CPT modifier 80 yielded an additional 1120 wRVUs. Using the assistant surgeon billing rate for directly supervised activities and the Medical Group Management Association nationwide median neurosurgery reimbursement rate, the on-call activities of a single resident generated a theoretical billing value of $689,514 over the 2-year period, or $344,757 annually. As a program, the on-call residents collectively produced 39,550 wRVUs over the study period, or 19,775 wRVUs annually, which equates to potential reimbursements of $1,668,386 annually.

CONCLUSIONS

Neurosurgery residents at the authors’ institution theoretically produce enough economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.

ABBREVIATIONS ATC = adult level 1 trauma center; CH = children’s hospital; CMS = Centers for Medicare and Medicaid Services; CPT = Current Procedural Terminology; DGME = direct graduate medical education; EVD = external ventricular drain; ICP = intracranial pressure; MGMA = Medical Group Management Association; NSQIP = National Surgical Quality Improvement Program; OR = operating room; PRA = per-resident amount; UH = university hospital; VAMC = Veterans Affairs Medical Center; wRVU = work relative value unit.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Paul Klimo Jr.: Semmes Murphey, Memphis, TN. pklimo@semmes-murphey.com.

ACCOMPANYING EDITORIAL DOI: 10.3171/2020.4.JNS20836.

INCLUDE WHEN CITING Published online September 11, 2020; DOI: 10.3171/2020.3.JNS193454.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Fact sheet: graduate medical education—optimizing graduate medical education. Association of American Medical Colleges. Accessed June 9, 2020. https://aamc-orange.global.ssl.fastly.net/production/media/filer_public/a5/8b/a58b3e4b-cec3-410d-9737-e800dfcded28/optimizinggmereport.pdf

  • 2

    Wynn BO, Smalley R, Cordasco KM. Does it cost more to train residents or to replace them? A look at the costs and benefits of operating graduate medical education programs. RAND Corporation. Accessed June 9, 2020. https://www.rand.org/pubs/research_reports/RR324.html

    • Export Citation
  • 3

    Survey of resident/fellow stipends and benefits report: 2018-2019. Association of American Medical Colleges. Accessed June 9, 2020. https://www.aamc.org/download/493114/data/2018stipendsurveyreportfinal.pdf

  • 4

    Chandra A, Khullar D, Wilensky GR. The economics of graduate medical education. N Engl J Med. 2014;370(25):23572360.

  • 5

    Statement of the American Association of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons, Society of Neurological Surgeons before the Institute of Medicine on the subject of ensuring an adequate neurosurgical workforce for the 21st century. American Association of Neurological Surgeons. Accessed June 9, 2020. https://www.aans.org/pdf/Legislative/Neurosurgery%20IOM%20GME%20Paper%2012%2019%2012.pdf

    • Search Google Scholar
    • Export Citation
  • 6

    Seicean A, Kumar P, Seicean S, Impact of resident involvement in neurosurgery: an American College of Surgeons’ National Surgical Quality Improvement Program database analysis of 33,977 patients. Neurospine. 2018;15(1):5465.

    • Search Google Scholar
    • Export Citation
  • 7

    Lim S, Parsa AT, Kim BD, Impact of resident involvement in neurosurgery: an analysis of 8748 patients from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. J Neurosurg. 2015;122(4):962970.

    • Search Google Scholar
    • Export Citation
  • 8

    Drolet BC, Tandon VJ, Sargent R, Revenue generation and plastic surgery training programs: 1-year evaluation of a plastic surgery consultation service. Plast Reconstr Surg. 2016;138(3):539e542e.

    • Search Google Scholar
    • Export Citation
  • 9

    Feinstein AJ, Deckelbaum DL, Madan AK, McKenney MG. Unsupervised procedures by surgical trainees: a windfall for private insurance at the expense of graduate medical education. J Trauma. 2011;70(1):136140.

    • Search Google Scholar
    • Export Citation
  • 10

    Jackson JB III, Vincent S, Davies J, A prospective multicenter evaluation of the value of the on-call orthopedic resident. J Grad Med Educ. 2018;10(1):9194.

    • Search Google Scholar
    • Export Citation
  • 11

    Krebiehl J, Adams N, Ford RD. A snapshot into the work of an on-call plastic and reconstructive surgery resident. Plast Reconstr Surg Glob Open. 2016;4(10):e1104.

    • Search Google Scholar
    • Export Citation
  • 12

    Ng M, Lawless ST. What if pediatric residents could bill for their outpatient services? Pediatrics. 2001;108(4):827834.

  • 13

    Gordon WE, Gienapp AJ, Jones M, An analysis of the on-call clinical experience of a junior neurosurgical resident. Neurosurgery. 2019;85(2):290297.

    • Search Google Scholar
    • Export Citation
  • 14

    Benzil DL, Zusman EE. Defining the value of neurosurgery in the new healthcare era. Neurosurgery. 2017;80(4S):S23S27.

  • 15

    Kenning TJ. Down the rabbit hole: attempting to decipher the value and salaries of neurosurgical residents. AANS Neurosurgeon. 2015;24(4).

    • Search Google Scholar
    • Export Citation
  • 16

    Resnick AS, Corrigan D, Mullen JL, Kaiser LR. Surgeon contribution to hospital bottom line: not all are created equal. Ann Surg. 2005;242(4):530539.

    • Search Google Scholar
    • Export Citation
  • 17

    Stoller J, Pratt S, Stanek S, Financial contribution of residents when billing as “junior associates” in the “surgical firm”. J Surg Educ. 2016;73(1):8594.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1521 1521 1521
Full Text Views 180 180 180
PDF Downloads 57 57 57
EPUB Downloads 0 0 0