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William E. Gordon, William M. Mangham, L. Madison Michael II and Paul Klimo Jr.

study of 4 resident orthopedic on-call services at 4 tertiary academic medical centers found that 9142 wRVUs could be generated collectively over a 90-day period by these on-call orthopedic services from consultations and performing procedures. 10 Our study suggests that the value of services provided by on-call neurosurgery residents is quite significant and far exceeds the cost of training with respect to GME funding. Limitations of the Study This study resulted from a single neurosurgical resident quantifying his on-call experience, and as such the data are

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Kiarash Shahlaie and Griffith R. Harsh IV

each of these activities, using evaluation and management codes for consults and admissions, and Current Procedural Terminology (CPT) codes for bedside procedures and assistant services in the operating room (OR). In total, the authors determined that the resident’s on-call activities represented 8172 wRVUs, which, if billable, could have generated $344,757 per year. 2 The authors state that the financial value of on-call services alone far exceeds the annual costs of resident training, and that their results provide insight into the economic benefits of resident

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Marco Cenzato, Francesco DiMeco, Marco Fontanella, Davide Locatelli and Franco Servadei

innovative element compared with the usual competitive setting. Thanks to the cooperation and collaboration of more than 20 neurosurgeons from spoke hospitals and also some spine orthopedic surgeons, the number of on-duty neurosurgeons at hub hospitals was doubled. In addition, at each hub hospital, one on-call service of complex spinal surgery and one of vascular surgery are set up. From the hub-and-spoke system establishment, all neurosurgical units in spoke hospitals gradually became inactive within a week. Thus, the number of neurosurgical departments managing

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significant economic value, both through indirect and directly supervised activities. We 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 total number of consultations, admission, 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 our institution produced 8,220 work relative value units (wRVUs