Assessing Physician Resident Contributions to Outpatient Clinical Workload

Area of Science:

• Medical Education
• Health Services Research
• Outpatient Care Delivery

Background:

• Graduate medical education primarily occurs in hospitals, contrasting with the predominantly outpatient nature of patient care.
• A potential gap in training site funding may limit residency positions in community and hospital-based outpatient clinics.

Purpose of the Study:

• To assess if physician residents' outpatient workload contribution financially offsets their training expenses (supervision, salary, benefits).
• To evaluate resident productivity and efficiency as they develop into independent practitioners within an outpatient setting.

Main Methods:

• Analysis of Veterans Affairs electronic health records from 2005-2018.
• Utilization of generalized linear mixed models to quantify resident and staff workload contributions using relative value units.
• Calculation of resident participation, productivity, efficiency, and progressive independence rates.

Main Results:

• Resident participation rates in outpatient workload varied by specialty (e.g., 11% primary care, 13% psychiatry).
• Productivity rates ranged widely (21%-94%), with primary care at 57% and psychiatry at 61%.
• Efficiency and progressive independence rates also showed significant variation across specialties, indicating different learning curves and contributions.

Conclusions:

• Residents in most VA clinics generate revenue that covers their direct training costs.
• Federal subsidies may be required to incentivize the placement of residents in less financially viable outpatient settings, particularly in primary care and mental health.
• Ensuring adequate training sites is crucial for a well-rounded physician workforce.