Marta E Heilbrun1, Brad Poss2, Luca Boi3, Yoshimi Anzai4, Nan Hu5, Robert S Kaplan6. 1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road - Room CG22, Atlanta, GA 30322. Electronic address: marta.heilbrun@emory.edu. 2. Department of Pediatrics, University of Utah Health, Salt Lake City, Utah. 3. University of Utah Health, Salt Lake City, Utah. 4. Department of Radiology and Imaging Sciences, University of Utah Health, Salt Lake City, Utah. 5. Department of Medicine, University of Utah Health, Salt Lake City, Utah. 6. Harvard Business School, Boston, Massachusetts.
Abstract
RATIONALE AND OBJECTIVES: To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure. MATERIALS AND METHODS: In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015-16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05). RESULTS: The annual cost of a DR resident was $99,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was $4.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27-180) minutes compared to 51 (IQR, 18-129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71-469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pm-9 am and weekends with residents is 44 (IQR, 18-119) minutes vs 60 (IQR, 18-179) minutes without. CONCLUSION: The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.
RATIONALE AND OBJECTIVES: To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure. MATERIALS AND METHODS: In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015-16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05). RESULTS: The annual cost of a DR resident was $99,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was $4.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27-180) minutes compared to 51 (IQR, 18-129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71-469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pm-9 am and weekends with residents is 44 (IQR, 18-119) minutes vs 60 (IQR, 18-179) minutes without. CONCLUSION: The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.
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