Table 8.

Costing out the IOM recommendations

Estimated $1.7 billion cost is based on replacing the equivalent of 8,247 resident physicians Attending physicians: 5,001 Mid-level practitioners: 5,984 Licensed vocational nurses: 320 Nursing aides: 229 Laboratory technicians: 45 Increasing residency slots is another option Some caveats on the cost estimates No reliable data on total work hours by specialty Considered only reduction in resident physician work hours Did not consider the cost of other recommendations – Increasing supervision – Resident physician transportation – Compliance monitoring Assumed 1-to-1 replacement ratio Did not consider potential savings from work and education redesign and ways to reduce resident physician hours without replacement costs Putting the $1.7 billion cost estimate into perspective For the average hospital – Estimated cost is $1.3 million – Cost per admission is $89.61 Total costs represent – About 9% of total funding for GME costs – 0.4% of Medicare outlays Impact on preventable adverse events is not known – 7% reduction would yield societal savings that offset cost of reducing resident physician hours

Barbara Wynn Senior Health Policy Analyst, Rand Corporation using data from Nuckols and Escarce, 2005 and Sleep, Supervision and Safety, IOM 2009