The effects of TRICARE implementation on general surgery residency training at Travis Air Force Base

Abstract

Purpose TRICARE is the military version of health care insurance. The conversion from CHAMPUS (the former version) to TRICARE was completed at David Grant Medical Center (DGMC) in October 1995. Because of a perceived decrease in the overall surgical caseload at DGMC in recent years, a review of the operative case logs of all graduating chief residents in general surgery was undertaken. The goal was to determine if institution of TRICARE was adversely affecting the surgical experience of our residents. Methods A retrospective review of the residency review committee (RRC) case logs of all graduating chief residents in general surgery at David Grant Medical Center was performed from 1990 to 1999. The review was divided into 2 groups: group 1 included all individuals who graduated in those years before initiation of TRICARE (1990 to 1995); group 2 included those who graduated after the initiation of TRICARE (1996 to 1999). Each of the 16 separate RRC reporting categories and 3 summary categories were compared to detect differences in overall caseloads between group 1 and group 2. Results Compared with group 1, group 2 had significantly fewer aortic, pediatric surgery, endoscopy, and total cases done in the chief year. Conclusions Since the initiation of the TRICARE health plan at David Grant Medical Center, overall caseloads have not declined. However, there has been a concerning decline in chief resident-year cases. This decline may not become fully apparent for several more years as the current junior residents report their caseloads upon their graduation. (Curr Surg 57:359–362)