Comparing Hospitalist-Resident to Hospitalist-Midlevel Practitioner Team Performance on Length of Stay and Direct Patient Care Cost

J Grad Med Educ. 2015 Mar;7(1):65-9. doi: 10.4300/JGME-D-14-00234.1.


Background: A perception exists that residents are more costly than midlevel providers (MLPs). Since graduate medical education (GME) funding is a key issue for teaching programs, hospitals should conduct cost-benefit analyses when considering staffing models.

Objective: Our aim was to compare direct patient care costs and length of stay (LOS) between resident and MLP inpatient teams.

Methods: We queried the University HealthSystems Consortium clinical database (UHC CDB) for 13 553 "inpatient" discharges at our institution from July 2010 to June 2013. Patient assignment was based on bed availability rather than "educational value." Using the UHC CDB data, discharges for resident and MLP inpatient teams were compared for observed and expected LOS, direct cost derived from hospital charges, relative expected mortality (REM), and readmissions. We also compared patient satisfaction for physician domain questions using Press Ganey data. Bivariate analysis was performed for factors associated with differences between the 2 services using χ(2) analysis and Student t test for categorical and continuous variables, respectively.

Results: During the 3-year period, while REM was higher on the hospitalist-resident services (P < .001), LOS was shorter by 1.26 days, and per-patient direct costs derived from hospital charges were lower by $617. Patient satisfaction scores for the physician-selected questions were higher for resident teams. There were no differences in patient demographics, daily discharge rates, readmissions, or deaths.

Conclusions: Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. The findings offer guidance when considering GME costs and inpatient staffing models.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Competence*
  • Female
  • Hospital Costs / statistics & numerical data*
  • Hospital Mortality
  • Hospitalists / economics*
  • Humans
  • Internship and Residency / economics*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nurse Practitioners / economics*
  • Patient Care Team / economics*
  • Patient Readmission / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Physician Assistants / economics*
  • Quality Indicators, Health Care*
  • Salaries and Fringe Benefits