Evaluating the effect of resident involvement on physician productivity in an academic general internal medicine practice

Abstract

Purpose: To estimate the effect of resident involvement across three years of resident training in a general internal medicine practice on the productivity of faculty physicians at Rush University Medical Center.

Method: Productivity was measured by work relative value units (RVUs) per clinical full-time equivalent attending physician generated in the ambulatory practice between July 2004 and June 2005. Random-effects linear regression models were used to estimate the impact of resident involvement by year of resident on attending physician productivity, controlling for faculty physician demographic characteristics.

Results: Resident involvement significantly reduced physician productivity. Each first-year resident was associated with a loss of 0.81 work RVUs per attending physician per four-hour clinic session. Each second-year and third-year resident was associated with a loss of 0.88 work RVUs and 0.49 work RVUs per attending physician per session, respectively. The loss per resident per session translated into a loss of 2,447 work RVUs for the year for the practice.

Conclusions: Physician productivity significantly decreased with resident involvement, but the impact varied across resident training years. The loss in productivity for the year was $164,000 in revenue or $49 per resident per session. Results of this study provide insight into the importance of considering teaching responsibilities when establishing productivity targets, particularly in practices where the level of teaching involvement varies across faculty physicians. External benchmarks with other general internal medicine practices would be more accurate when resident teaching responsibilities are accounted for.