Assessing the Value of Work Done by an Orthopedic Resident During Call

Medicare funding for graduate medical education may be cut in the next federal budget.

We quantified the value of work that 1 orthopedic surgery resident performs on call and compare it to Medicare educational funding received by the hospital for each resident.

A single orthopedic resident's on-call emergency department and inpatient consults were collected during a 2-year call period at a large, tertiary, level-1 trauma center. Patient charts were reviewed; ICD-9 codes, evaluation and management, and procedural treatment were recorded. Codes were converted into work relative value units. The number of work relative value units was multiplied by the 2012 Medicare rate of $34.03 per relative value units to calculate the monetary value of resident work.

Of 120 resident call shifts, 115 call sheets (95.8%) were available for review, and 1160 patients were seen (average  =  10.09 consults/call). A total of 4688 work relative value units were generated (average  =  40.76 per night), and the total dollar value generated was $159,561 ($1,387 per call) during the 2 years of call (average  =  $79,780 annually). Evaluation and management codes generated 2340 work relative value units, with a calculated dollar amount of $79,648, and procedural codes generated 2348 work relative value units, with a calculated dollar amount of $79,913.

Our institution estimated Medicare direct medical education support per resident at $40,000/y, and total funding was $130,000/resident. At our tertiary care institution, the unbilled work of 1 orthopedic resident on call amounts to more than 60% of Medicare direct medical education and indirect medical education funding annually.