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NESS 2006 Annual Meeting
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Predicting Future Staffing Needs at Teaching Hospitals: Use of an Analytical Program With Multiple Variables
Christine Mitchell, Stanley Ashley, Michael Zinner, Francis D Moore, Jr.
Brigham and Women's Hospital, Boston, MA

Objective: Changes in surgical education require strategies to replace resident service function.
Interventions: A computerized model of surgery services with future variables was constructed, including: number/level of resident staff and fellows (ACGME or non-approved), number/type of physician extenders, wages, work hours, relative educational value of teaching rotations, work units on floors, operating rooms, and clinics, future volume growth, and work efficiency.
Outcomes: Number of staff needed, staffing expense, educational impact.
Results: On a hypothetical busy general surgery service, we estimated the impact of reducing resident service work over the next 5 years. Projecting modest volume growth requires the hiring of 8 PAs at a cost of ,012,000. A 10% improvement in the efficiency of floor care, as gained by added IT capability or use of service-specific care units, can mitigate these expenses by as much as 40%. Implementing one day/wk of simulator/educational time or improving the educational value of current rotations adds even more personnel costs. Further reduction in resident work hours to 50/wk or 40/wk in 2009 would increase the costs to ,215,000 and ,817,000, respectively.
Conclusions: We developed a relatively simple model for fiscal planning in the context of current trends in surgical education. This model suggests that replacing residents with PAs in order to provide tertiary care on surgery floors requires large amounts of human and fiscal capital. The potential for simple efficiencies to mitigate some of this expense suggests that traditional patterns of care in teaching hospitals will have to change in response to educational mandates.

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