Training Costs in a Surgical Subspecialty

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Abstract

BACKGROUND:

Resident training is expensive, ∼$80,000/resident/year. As the healthcare system evolves, residencies must evolve to produce physicians competent to meet future needs and challenges. Yet additional GME dollars haven't accompanied IOM calls for a larger, high-quality physician workforce. Current funding may already be insufficient. We wanted more clarity about the real costs of training in a surgical subspecialty.

METHODS:

The minimum thresholds for surgeries performed by generalist OBGYNs are: Cesarean=145; TAH=35; TVH=15; TLH=20; Incontinence=25; Cystoscopy=10; Laparoscopy=60; Hysteroscopy=40; Total=350. We assigned each PGY a proportional threshold and OR time based on historical reports—longer durations to novice-advanced beginners and shorter durations to competent-proficient surgeons. We estimated hours of surgery-related clinical activities (CA). Faculty: surgery conference (1-h/wk); outpatient pre-op and post-op appointments and checkouts (4-h/wk and 2-h/wk); inpatient pre-op (5 min/procedure); rounding-morning (1-h/shift×5-days×4-residents); rounding-evening (1-h/shift×5-days); case preparation (30-min/procedure); case logs (5 min/procedure) evaluation (5 min/procedure); and simulation (16-h/year×4-faculty). Residents: surgery conference (1-hr/wk); outpatient pre-op and post-op appointments and checkouts (4-h/wk and 4-h/wk, respectively); inpatient pre-op (5 min/procedure); inpatient supervision (1-h/shift×5-days); case preparation (15-min/procedure); evaluation (5 min/procedure); and simulation (16-h/resident). We calculated the mean generalist hourly wage (salary+benefits/40 hours/52 weeks; no call) and the mean hourly wage by PGY (salaries+benefits/80 hours/52 weeks).

RESULTS:

Total costs=$323,389: Faculty=$194,462 (OR=$70,836; CA=$123,626); Residents=$128,927 (OR=$9,281; CA=$119,646).

DISCUSSION:

Meeting minimum surgical thresholds exceeds the ∼$320,000/resident/4 years. To include training costs of L&D, ambulatory care, cancer procedures and other experiences of robust physician education, funding streams, (direct and indirect dollars) must evolve also.

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