The cost of teaching residents outpatient obstetrics and gynecology in a university medical center.

OBJECTIVE: To quantify the cost of teaching residents ambulatory obstetrics and gynecology, expressed as the difference in revenue generated between a faculty physician practicing as a private practitioner and a faculty physician serving as a resident supervisor. METHOD: Outpatient revenue generated by faculty generalists and residents was analyzed. The net gain in revenue was calculated per half-day session for faculty and residents by subtracting contractual allowances and expenses from gross patient charges. Net revenue gain per half-day clinical session per year for a faculty member practicing as a private practitioner was compared with that of a faculty member functioning as a supervisor. The net gain for the faculty supervisor was based on the revenue generated by the residents supervised. RESULTS: The faculty member serving as a private practitioner generated a net gain per session per year of $23,947. The faculty member acting as supervisor for two residents per session generated a net gain or loss per session per year of -$9678, -$972, and $15,542 for first-, second-, and third-year residents, respectively. The cost of teaching, expressed as the difference in the net gain of a faculty member as private practitioner and the net gain of a faculty member as supervisor, for first-, second-, and third-year residents was $33,625, $24,919, and $8405, respectively, per session per year. CONCLUSION: This analysis shows that first-year residents are an expense to the practice site, second-year residents are close to breaking even, and third-year residents begin to generate a net gain.

Assessing information for consumers on the quality of medical care.

In recent years support for better public information on the quality of medical care has intensified, while the validity of the information available has been questioned. To address these concerns, we evaluated the reliability and validity of using each of 10 possible indicators to measure hospital and physician quality and the feasibility of providing the results to the public. We found that several of these indicators can provide useful, though not definitive, information on quality. In general, we advise consumers to combine information from more than one year and from more than one indicator to increase the likelihood that the relationship is accurate. For the provision of information on quality to achieve its potential, certain deficiencies in quality assessment must be addressed by both public and private policies. Strengthening the validity of quality assessments is vital to improve their credibility and to minimize negative effects on medical providers, individual consumers, and health care programs.