Consultant duration of clinical practice as a cost determinant of an emergency medical admission

Abstract

Background: Little data exists relating years of hospital consultant work experience, from time of consultant certification, and costs incurred for emergency medical patients under their care. We examined the total cost of emergency medical episodes in relation to certified consultant years experience using a database of emergency admissions.

Methods: All emergency admissions (19,295 patients) from January 2008 to December 2012 were studied. Consultants were categorized by total years of certified experience according to four experience categories (< 15, 15-20, > 20 to ≤ 25, and > 25 years). Costs per case calculations included all pay, non-pay, and diagnostic/support infra-structural costs. We used quantile regression analysis to examine the impact of predictor variables on total costs over the predictor distribution and logistic regression on outcomes and costs, adjusting for other major predictors of cost.

Results: Major predictors of costs were identified. Quantile regression cost parameter estimates of hospital episode costs decreased with experience; the unit change at the Q25 point of the years experience distribution was -<euro> 62 (95 % CI -<euro> 87, -<euro> 37), -<euro> 162 (95 % CI -<euro> 203, -<euro> 120) at the median, but decreased at the Q75 point to -<euro> 340 (95 % CI -<euro> 416, -<euro> 264). The odds ratio of a hospital episode cost being below the median for each category of consultant experience >15 years qualified were 0.75 (95 % CI 0.68, 0.83), 0.77 (95 % CI 0.70, 0.86), and 0.70 (95 % CI 0.64, 0.78): p < 0.001 for each experience category vs. <15 years qualified.

Conclusions: There appear to be cost advantages to care delivered by certified consultants of >20 years in clinical practice.