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The Effect of Nonteaching Services on the Distribution of Inpatient Cases for Internal Medicine Residents

O'Connor, Alec B. MD, MPH; Lang, Valerie J. MD; Lurie, Stephen J. MD, PhD; Lambert, David R. MD; Rudmann, Andrew MD; Robbins, Brett MD; Bordley, Donald R. MD

doi: 10.1097/ACM.0b013e3181939718
Graduate Medical Education

Purpose: Nonteaching services (NTSs) are becoming increasingly prevalent in academic hospitals. This study was designed to determine whether the presence of an NTS is associated with higher acuity and altered case mix on the teaching service.

Method: The authors carried out a retrospective, cross-sectional analysis of data about all general medical admissions between January 1, 2005 and June 30, 2005 to either of two teaching hospitals in Rochester, New York. A total of 6,907 inpatients were studied, of whom 1,976 (29%) were admitted to medicine resident services and 4,931 (71%) were admitted to NTSs. Hospital billing databases were used to determine patient demographics, ICD-9 diagnoses, Charlson Comorbidity Index scores, and patient disposition.

Results: Compared with NTS patients, patients on resident services had higher median Charlson Comorbidity Index scores (3.0 versus 2.0, P < .001) and numbers of comorbidities (9.0 versus 8.0, P < .001) and were more likely to require intensive care (15.5% versus 7.6%, P < .001) and to die in the hospital (8.2% versus 4.5%, P < .001). Patients on the resident services were more likely to have acute renal failure, respiratory failure, septicemia, and HIV. Residents were less likely to care for patients with primary diagnoses of chest pain, cellulitis, alcohol withdrawal, and sickle cell crisis. The differences in patients' conditions between resident services and NTSs were similar in the two hospitals and also among patients who had not received intensive care.

Conclusions: Patients on resident services may be more medically complex and more likely to have high-acuity diagnoses than patients on NTSs. How these differences affect residents' education, residents' career decisions, and practice styles deserves further study.

Dr. O'Connor is assistant professor of medicine, Department of Medicine, and associate program director, Medicine and Medicine/Pediatrics Residencies, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Dr. Lang is assistant professor of medicine, Department of Medicine, and director, Internal Medicine Clerkship and Subinternship, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Dr. Lurie is assistant professor of family medicine, Department of Family Medicine, and director of assessment, Office of Curriculum and Assessment, University of Rochester School of Medicine and Dentistry.

Dr. Lambert is associate professor of medicine, Department of Medicine, and senior associate dean for medical student education, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Dr. Rudmann is associate professor of medicine, Department of Medicine, and chief, Hospital Medicine Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Dr. Robbins is associate professor of medicine and pediatrics, Departments of Medicine and Pediatrics, and program director, Medicine/Pediatrics Residency, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Dr. Bordley is professor of medicine, Department of Medicine, program director, Medicine Residency, and associate chair for education, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. O'Connor, Box MED/HMD, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, NY 14642; telephone: (585) 275-4912; fax: (585) 276-2144; e-mail: (alec_oconnor@urmc.rochester.edu).

© 2009 Association of American Medical Colleges