The Resident to Midlevel Ratio

As a great bookend to my recent brief article about resident pay, here’s an interesting little data point from this article about the shutdown of UNM’s neurosurgery residency for ACGME violations:

In the immediate future, UNM plans to double the number of neurosurgeons on staff by March. They have also hired 23 advanced practice providers to the staff to handle the workload of the departing residents.

23! There are 10 residents total. Even ignoring the attending coverage (which could in part be needed to provide adequate supervision), 23:10 is an amazing ratio.

To be sure, neurosurgery is one of if not the most valuable residency fields for a hospital. And highly trained upper-level residents obviously are capable of providing high-level and highly-remunerative largely independent care. And, in this case, the workload was clearly too much for even the ten residents they did have. According to the NRMP match data from the past several years, UNM only offered 1 spot in the match (and has over the past decade offered 2 in some years), so I can imaging the call burden must have been absolutely insane.

But damn.

And, just for fun, here’s a back of the napkin cost analysis:

Here’s a breakdown of UNM resident salaries for 2019-2020:

  • PGY I $53,898
  • PGY II $55,646
  • PGY III $57,671
  • PGY IV $59,800
  • PGY V $62,396
  • PGY VI $64,692
  • PGY VII $67,343

So, on average: $60,206 (we know that two of the residents are graduating this year, so a simple average isn’t quite right, but it works for illustrative purposes).

According to “salary.com”, staring PA/NP salaries in the area average around $92,000.

So, as usual, a new midlevel outearns even an overtrained senior resident.

And, with 23 advanced practice providers to replace 10 residents, UNM can expect to spend around $1.5 million more per year to replace residents with nonphysician providers.

(That doesn’t include the residents’ salaries themselves, which UNM must also continue to pay while the residents continue training elsewhere as part of losing their ACGME accreditation. Assuming 8 residents evenly distributed, adding those back in is would be in the neighborhood of another $2 million (though presumably that money really comes from CMS and represents a loss to the system of that sweet extra dough not eaten up by salary/benefits that helps pay for the “cost” of training a resident, maybe an extra $ 1 million total).

A pretty costly mistake, to be sure. But given the bare-bones staffing UNM was presumably using for years, they probably still end up in the black.

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