The query surrounding graduate medical education (GME) programs and their faculty revolves around whether they truly recognize the value of residents. Assessing their value can be subjective as well as objective. Here are some questions that programs, faculty, and residents should contemplate before drawing their own conclusions.
Do health care institutions incur financial losses when they have residents who cannot directly bill health care payers for their services, compared to institutions that employ physician assistants (PAs) and advanced practice registered nurses (APRNs) who can bill directly? On average, does the revenue generated by PAs and APRNs from health care payers outweigh the funds disbursed to programs primarily through the Centers for Medicare and Medicaid Services (CMS)? Can CMS shed some light on this by comparing the cumulative submitted charge amounts nationally, with and without GC modifiers, and the subsequent Medicare allowable amounts, with and without GC modifiers? This comparison could provide insights into the potential economic value of residents generating revenues indirectly. Would it be interesting if residents were allowed to bill directly, similar to PAs and APRNs? In such a scenario, would CMS still need to provide the same level of blanket payments for direct graduate medical education (DGME) and indirect medical education (IME), assuming residents are allowed to bill CMS at the lowest Medicare allowable rates for each submitted charge?
Do residents have to reach senior positions before they can express their genuine assessment of programs and their faculty, due to changes in their conflicts of interest over the years spent in the programs? Do mandated anonymous surveys administered to residents help keep programs and their faculty accountable, as residents possess the mandatory option to leave if they feel disconnected, unlike other workers whose exit surveys, after years of service, may be dismissed as disgruntled voices?
Do patients worry that residents may take too long to complete their management and procedures, unless the additional time spent on their cases adds value to the comprehensiveness of their care? If patient management and procedure completion become excessively rapid due to faculty aiming for quick turnover, does it result in unnecessary but billable care and avoidable procedures? Assuming that a certain percentage of unnecessary health care exists in all financially sound practices, whether or not residents are involved, can residents who provide comprehensive care help alleviate the overall skyrocketing health care costs by slowing down a system riddled with unnecessary care?
Should residents expect full disclosure of annual financial reports from programs? Is it unintentional philanthropy on the part of residents when their true value remains obscured due to the absence of direct billing for their services? With prior authorizations and claim reviews potentially serving as inadequate regulators, do residents, who provide slow but comprehensive care, help keep conflicts of interest between programs and faculty in check? Although the duration of undervaluation and potential overwork is limited to the few years of residency, unlike other workers with varying years of service, can seemingly undervalued and potentially overworked residents mistake it for labor trafficking? Is it possible that the system itself undervalues them or permits potential overwork due to the prohibitively high cost of alternative workers and their hourly rates?
It is crucial to recognize the true value of residents who are budding into future physicians. As providers for institutions and their patients, residents will care for programs and their faculty as they age and rely on new blood to sustain and survive.
Deepak Gupta is an anesthesiologist. Sarwan Kumar is an internal medicine physician.
