Re-Engineering Graduate Medical Education: An Analysis of the Contribution of Residents to Teaching Hospitals Utilizing a Model of an Internal Medicine Residency Program

According to the Institute of Medicine (IOM), the U.S. health care delivery system does not provide consistent, high-quality medical care to all people all the time. As a significant component of the health care delivery system, the state of Graduate Medical Education in the United States has prompted much analysis in recent years due to the general view that desired and actua l outcomes are increasingly at variance with each other. One area of focus has been the implications of change for provider credentialing and funding of graduate medical education. With this research we test the hypothesis that residents perform valuable work in the teaching hospitals where they undergo training, to inform the issue regarding provider credentialing for residents. We developed a framework to compare second-year residents (PGY2), physician assistants with one year of experience, and nurse practitioners with one year of experience to measurably address the interchangeability of providers. Data was collected by obtaining expert opinions on the proficiency of the three provider options (resident, physician assistant, nurse practitioner) in performing a set of tasks/procedures by surveying the program directors of Internal Medicine residency programs in the United States. The other residency programs at the University of South Florida’s College of Medicine were also surveyed to obtain measurable performance on the service providers. Statistical tools were used to analyze the survey responses, aggregate patient data and salary data for each provider. The data analysis and summary indicated that residents displayed higher levels of proficiency than physician assistants and nurse practitioners for the tasks investigated. The proficiency values were utilized as parameters to build a mathematical programming model with the objective of maximizing total proficiency by determining the optimal number of service providers. The model was developed and tested using data from two healthcare systems. This research demonstrates that residents perform productive work at teaching hospitals, within the scope of the tasks and dimensions evaluated. Additiona lly, residents work capabilities were considered in the development of a model that can be scaled to investigate questions regarding skill mix