NAS: Department and Institutional resources

AOA Department Chair Forum

Not Steve Albanese, MD

Disclosure: I am not Steve Albanese

Northwestern University Orthopaedic Surgery

• 9 Residents a Year, 2 ACGME Fellows

• Northwestern Memorial (28)

• Lurie Children’s Hospital (7)

• Cook County Stroger Hospital (5)

• Jessie Brown VA (5)

McGaw Foundation

• 1050 Residents (760 based at NMH)• DIO• 2 Staff FTE• Administrator FTE• MD ACMO• 2 FTE Quality -also do JCAHO• Financial Disclosure (?)• Between 10-45 Above Caps• Largely Hospital Funded

GME BudgetThe Black Hole and Orthopaedics

• Mc Gaw-NMH Resident Salaries and Benefits: $1.5 million (?)

• Others : $1.0 million• Program Coordinator NMH $53,000• Meals $50,000• Conferences/Books/Travel $40,000• Program Director $80,000• ACGME Fees

Departmental Expenses

• Department Staff .75 FTE $50,000• Res Coordinator .50 FTE $26,000• Parking (?)• Education Conferences/Travel/Books $60,000-

$30,000 grants/Industry=$30,000• Supplies $25,000• Thesis Day $10,000• Research Rent $38,500• Total Departmental=$175,000

What Will NAS Cost the Institution?

• McGaw “Not Increasing Budget”

• Once “System” Set Up-No Additional Expense

• One More FTE-Resident Management Systems

What Will NAS and The New Requirements Cost the

Department?

What Will It Cost the Department?

• Don’t Really Know• Additional Personnel/Time-Estimate 30% • Increase Job Rating for Program Coordinator

($25,000)• Program Director Longevity• Personal Capital• Education RVUs- 3000 at $50 per• Opportunity Cost-Time From Patient Care• Burnout Among Few Truly Interested

Literature or Published Experience on the Cost of Implementation

• None That I Can Find in Any Medical Field

• Depend on Program Size

• Depend on Faculty Willingness to Participate in Education

• Depend on Current Resources

• Largely Increased Time Commitment-Hard to Quantitate

Current Paperwork (bytework)

• Rotation Evaluations• Global Evaluations• 360 Evaluations• Faculty Evaluations• Program Evaluations• 6 Month Summaries• Resident and Faculty Surveys• Year End Summaries

Current Data Oversight

• Op Log Data

• Case Minimum

Add

• Specialty Specific Milestones

• General Competency Milestones

• Semi-Annual Submission of Milestones

• Competency Committee-Faculty and Staff

• Remediation Plans

• Simulation and Basic Skills Lab

• Faculty Education and Engagement

Costs of New Requirements

• People-Add 3-5 faculty members (eRVU) to Competency Committee and Staff (hourly)

• Time-Review evaluations, review specialty specific milestones, arrive at general competency milestones and submit recommendations

• Capital-ONE More Thing for Faculty

Add Time and Money for Basic Skills

• Curriculum Design and Set-up

• Time Required for Dedicated Instruction, Observation and Feedback

Subtract

• Time for PIF and Site Visit Preparation

• CV Submission

CLER Visits

• Unknown Effect on Departments

• Call Rooms, Electronic Access to Literature, Parking, Food

• Work Hours Environment

Net Effect

• We Don’t Really Know

• Significant Additional Expense to Departments Based on Size

• People-Faculty and Staff Effort

• Time-Milestone Process and Evaluation

• Capital-Faculty Energy and Enthusiasm

• Dollars-Staff Increases and Faculty Reimbursement

Real Cost to Leaders

• Identify and Invest in a Cadre of True Teachers

• Reward Them

• Shield Them From Burnout