BACKGROUND: More generalists are needed for the American health care system. Will training these practitioners add to hospital costs? Although graduate medical education has been shown to add to hospital patient care costs, the authors questioned whether this were true for the hospital training of family physicians. METHOD: Based on data supplied by 12 participating New Jersey hospitals with family practice residencies, inpatients in 1991 were separated into three categories by the teaching status of their attending physicians: family practice, other teaching, non-teaching. The hospitals were stratified into two types for analysis: seven community and five multiresidency hospitals. Average cost (per case-mix--neutral case) was found for each category of patients within medical, surgical, pediatric, and obstetrical classes. RESULTS: Among community teaching hospitals, the mean case-mix--adjusted cost per case for inpatients associated with family practice training was 6.3% less than that for inpatients with an equivalent case mix not associated with family practice training. Among multiresidency teaching hospitals, there was no difference between mean costs for inpatients associated with family practice training and non-teaching patients. The mean cost for inpatients associated with graduate medical training other than family practice was 8% higher than that for non-teaching inpatients. CONCLUSION: These findings suggest that family practice residencies do not add to the direct inpatient costs of teaching hospitals, and in certain instances may even reduce hospital patient care costs. In times of increasing cost consciousness in health care and medical education, this provides a further rationale for institutions to sponsor graduate training in family practice.
BACKGROUND: More generalists are needed for the American health care system. Will training these practitioners add to hospital costs? Although graduate medical education has been shown to add to hospital patient care costs, the authors questioned whether this were true for the hospital training of family physicians. METHOD: Based on data supplied by 12 participating New Jersey hospitals with family practice residencies, inpatients in 1991 were separated into three categories by the teaching status of their attending physicians: family practice, other teaching, non-teaching. The hospitals were stratified into two types for analysis: seven community and five multiresidency hospitals. Average cost (per case-mix--neutral case) was found for each category of patients within medical, surgical, pediatric, and obstetrical classes. RESULTS: Among community teaching hospitals, the mean case-mix--adjusted cost per case for inpatients associated with family practice training was 6.3% less than that for inpatients with an equivalent case mix not associated with family practice training. Among multiresidency teaching hospitals, there was no difference between mean costs for inpatients associated with family practice training and non-teaching patients. The mean cost for inpatients associated with graduate medical training other than family practice was 8% higher than that for non-teaching inpatients. CONCLUSION: These findings suggest that family practice residencies do not add to the direct inpatient costs of teaching hospitals, and in certain instances may even reduce hospital patient care costs. In times of increasing cost consciousness in health care and medical education, this provides a further rationale for institutions to sponsor graduate training in family practice.