Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.
Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.
J Surg Educ. 2019 Nov-Dec;76(6):e173-e181. doi: 10.1016/j.jsurg.2019.08.006. Epub 2019 Aug 26.
Surgical graduate medical education (GME) programs add both significant cost and complexity to the mission of teaching hospitals. While expenses tied directly to surgical training programs are well tracked, overall cost-benefit accounting has not been performed. In this study, we attempt to better define the costs and benefits of maintaining surgical GME programs within a large integrated health system.
We examined the costs, in 2018 US dollars, associated with the surgical training programs within a single health system. Total health system expenses were calculated using actual and estimated direct GME expenses (salary, benefits, supplies, overhead, and teaching expenses) as well as indirect medical education (IME) expenses. IME expenses for each training program were estimated by using both Medicare percentages and the Medicare Payment Advisor Commission study. The projected cost to replace surgical trainees with advanced practitioners or hospitalists was obtained through interviews with program directors and administrators and was validated by our system's business office.
A physician lead, integrated, rural health system consisting of 8 hospitals, a medical school and a health insurance company.
GME surgical training programs within a single health system's department of surgery.
Our health system's department of surgery supports 8 surgical GME programs (2 general surgery residencies along with residencies in otolaryngology, ophthalmology, oral-maxillofacial surgery, urology, pediatric dentistry, and vascular surgery), encompassing 89 trainees. Trainees work an average of 64.4 hours per week. Total health system cost per resident ranged from $249,657 to $516,783 based on specialty as well as method of calculating IME expenses. After averaging program costs and excluding IME and overhead expenses, we estimated the average annual cost per trainee to be $84,171. We projected that replacing our surgical trainees would require hiring 145 additional advanced practitioners at a cost of $166,500 each per year, or 97 hospitalists at a cost of $346,500 each per year. Excluding overhead, teaching and IME expenses, these replacements would cost the health system an estimated additional $16,651,281 or $26,119,281 per year, respectively.
Surgical education is an integral part of our health system and ending surgical GME programs would require large expansion of human resources and significant additional fiscal capital.
外科住院医师规范化培训（GME）项目给教学医院的使命增加了巨大的成本和复杂性。虽然与外科培训项目直接相关的费用得到了很好的跟踪，但总体成本效益核算尚未进行。在这项研究中，我们试图更好地定义在大型综合卫生系统内维持外科 GME 项目的成本和收益。
我们检查了一个单一卫生系统内外科培训计划相关的成本，以 2018 年美元计算。总卫生系统费用通过使用实际和估计的直接 GME 费用（工资、福利、用品、间接费用和教学费用）以及间接医学教育（IME）费用来计算。每个培训计划的 IME 费用通过使用 Medicare 百分比和 Medicare Payment Advisor Commission 研究来估算。通过与项目主任和管理人员的访谈获得了用高级执业医师或医院医师替代外科受训者的预计成本，并通过我们系统的业务办公室进行了验证。
一个由 8 家医院、一所医学院和一家保险公司组成的由医生主导的综合性农村卫生系统。
单一卫生系统外科部门的 GME 外科培训计划。
我们的卫生系统外科部门支持 8 个外科 GME 项目（2 个普通外科住院医师培训项目以及耳鼻喉科、眼科、口腔颌面外科、泌尿科、儿科牙科和血管外科住院医师培训项目），涵盖 89 名受训者。受训者平均每周工作 64.4 小时。根据专业和 IME 费用的计算方法，每位住院医师的总卫生系统成本从 249657 美元到 516783 美元不等。在平均项目成本并排除 IME 和间接费用后，我们估计每位受训者的平均年度成本为 84171 美元。我们预计，用 145 名额外的高级执业医师替代我们的外科受训者，每人每年需要花费 166500 美元，或者用 97 名医院医师替代，每人每年需要花费 346500 美元。不包括间接费用、教学和 IME 费用，这些替代方案将使卫生系统每年额外增加约 16651281 美元或 26119281 美元的成本。
外科教育是我们卫生系统的一个组成部分，停止外科 GME 项目将需要大量扩大人力资源和大量额外的财政资本。
