NAS: Department and Institutional resources AOA Department Chair Forum Not Steve Albanese, MD

Disclosure: I am not Steve Albanese

Northwestern University Orthopaedic Surgery 9 Residents a Year, 2 ACGME Fellows Northwestern Memorial (28) Lurie Children’s Hospital (7) Cook County Stroger Hospital (5) Jessie Brown VA (5)

McGaw Foundation 1050 Residents (760 based at NMH) DIO 2 Staff FTE Administrator FTE MD ACMO 2 FTE Quality -also do JCAHO Financial Disclosure (?) Between Above Caps Largely Hospital Funded

GME Budget The Black Hole and Orthopaedics Mc Gaw-NMH Resident Salaries and Benefits: $1.5 million (?) Others : $1.0 million Program Coordinator NMH $53,000 Meals $50,000 Conferences/Books/Travel $40,000 Program Director $80,000 ACGME Fees

Departmental Expenses Department Staff.75 FTE $50,000 Res Coordinator.50 FTE $26,000 Parking (?) Education Conferences/Travel/Books $60,000- $30,000 grants/Industry=$30,000 Supplies $25,000 Thesis Day $10,000 Research Rent $38,500 Total Departmental=$175,000

What Will NAS Cost the Institution? McGaw “Not Increasing Budget” Once “System” Set Up-No Additional Expense One More FTE-Resident Management Systems

What Will NAS and The New Requirements Cost the Department?

What Will It Cost the Department? Don’t Really Know Additional Personnel/Time-Estimate 30% Increase Job Rating for Program Coordinator ($25,000) Program Director Longevity Personal Capital Education RVUs at $50 per Opportunity Cost-Time From Patient Care Burnout Among Few Truly Interested

Literature or Published Experience on the Cost of Implementation None That I Can Find in Any Medical Field Depend on Program Size Depend on Faculty Willingness to Participate in Education Depend on Current Resources Largely Increased Time Commitment-Hard to Quantitate

Current Paperwork (bytework) Rotation Evaluations Global Evaluations 360 Evaluations Faculty Evaluations Program Evaluations 6 Month Summaries Resident and Faculty Surveys Year End Summaries

Current Data Oversight Op Log Data Case Minimum

Add Specialty Specific Milestones General Competency Milestones Semi-Annual Submission of Milestones Competency Committee-Faculty and Staff Remediation Plans Simulation and Basic Skills Lab Faculty Education and Engagement

Costs of New Requirements People-Add 3-5 faculty members (eRVU) to Competency Committee and Staff (hourly) Time-Review evaluations, review specialty specific milestones, arrive at general competency milestones and submit recommendations Capital-ONE More Thing for Faculty

Add Time and Money for Basic Skills Curriculum Design and Set-up Time Required for Dedicated Instruction, Observation and Feedback

Subtract Time for PIF and Site Visit Preparation CV Submission

CLER Visits Unknown Effect on Departments Call Rooms, Electronic Access to Literature, Parking, Food Work Hours Environment

Net Effect We Don’t Really Know Significant Additional Expense to Departments Based on Size People-Faculty and Staff Effort Time-Milestone Process and Evaluation Capital-Faculty Energy and Enthusiasm Dollars-Staff Increases and Faculty Reimbursement

Real Cost to Leaders Identify and Invest in a Cadre of True Teachers Reward Them Shield Them From Burnout