Financial impact of in-house attending surgeon: a prospective study

Current work hour restrictions have required some programs to have staff surgeons cover in-house call. Other programs have considered in-house staff coverage at night for the billable tasks performed during these hours. However, there have been no data published describing the load or value of work that an in-house team performs at night. Therefore, we prospectively recorded tasks performed in a pediatric surgery training center after staff had left for the night.

Between April 2005 and March 2006, all services rendered from 6:00 PM to 6:00 AM that would require staff presence were prospectively recorded by a pediatric surgical fellow on-call. Tasks performed while staff was in the hospital were excluded. Time of service was recorded and assigned to an hour of the night. Billing codes were identified for each task, and relative value units were assigned. The collectable amount for services was calculated using 2006 Medicare reimbursement. Data were analyzed in functional blocks (6:00-10:00 PM, 10:00 PM-4:00 AM, and 4:00-6:00 AM).

Data from 111 call nights were collected over the year. Attending staff was in-house 10 of those nights. Of the remaining 101 nights, peak hour of activity was from 12:00 AM to 1:00 AM (35 nights). In the 10:00 PM to 4:00 AM time block, service was rendered 80 nights considering all activity, 68 nights if trauma/burns were excluded, and 45 nights excluding trauma/burns and nonoperative admissions. The sum collectable for all overnight services for the year was $25,855.

The in-house resident team performs tasks through the middle of the night on most nights. However, billable revenue generated by these tasks is very small compared with revenue generated from the normal operative schedule.