Regenstein Marsha, Trott Jennifer, Ku Leighton, Snyder John, Kepley Hayden, Carter Kennita, Twyman Tonya, Baños Jacqueline
Acad Med. 2025 May 1;100(5):628-634. doi: 10.1097/ACM.0000000000005961. Epub 2025 Jan 7.
A cost evaluation of the Teaching Health Center Graduate Medical Education (THCGME) program was conducted to measure direct medical education (DME) and indirect medical education (IME) costs, assess the effect of teaching health center (THC) characteristics on residency training costs, and develop a method and formula for per-resident amount (PRA) payments in baseline and future years for the THCGME program.
A costing instrument was developed by George Washington University researchers to collect academic year 2018 to 2019 cost data from 50 of 55 THCs to determine DME expenses. The investigators conducted 3 rounds of review on submitted instruments and provided technical assistance to THCs as needed. Health center-based THC sites were compared with health centers without training programs to investigate IME expenses using the Uniform Data System, interviews, and data from 4 health centers with training and nontraining sites.
After adjustment for inflation, the THCGME program PRA for academic year 2024 to 2025 was estimated at $227,164 based on median per-resident total expenses ($328,507) and revenues ($101,343). Resident and faculty compensation represented more than half of PRA expenses, with the remaining being other educational costs and operational or administrative expenses. Patient services represented 97% of revenues. Investigations into IME costs did not yield identifiable estimates.
The cost evaluation revealed that the PRA currently used in the THCGME program underfunds actual net training costs. The investigators offer 3 THCGME program recommendations: (1) use a payment formula to annually adjust the PRA for inflation, understanding that such a payment policy requires legislative (appropriations) and executive branch (implementation) action; (2) use a PRA that remains a single, fixed payment without adjustment for THC characteristics; and (3) provide no additional funding for IME, given limited supporting data to justify assigning additional costs to THC-based training, given its ambulatory context.
对教学健康中心研究生医学教育（THCGME）项目进行成本评估，以衡量直接医学教育（DME）和间接医学教育（IME）成本，评估教学健康中心（THC）特征对住院医师培训成本的影响，并制定THCGME项目在基线年和未来年份每位住院医师金额（PRA）支付的方法和公式。
乔治华盛顿大学的研究人员开发了一种成本核算工具，从55个THC中的50个收集2018至2019学年的成本数据，以确定DME费用。研究人员对提交的工具进行了三轮审查，并根据需要向THC提供技术援助。将以健康中心为基础的THC站点与没有培训项目的健康中心进行比较，使用统一数据系统、访谈以及来自4个有培训和无培训站点的健康中心的数据来调查IME费用。
在对通货膨胀进行调整后，根据每位住院医师的总费用中位数（328,507美元）和收入（101,343美元），估计2024至2025学年THCGME项目的PRA为227,164美元。住院医师和教职员工薪酬占PRA费用的一半以上，其余为其他教育成本以及运营或行政费用。患者服务占收入的97%。对IME成本的调查未得出可识别的估计值。
成本评估显示，THCGME项目目前使用的PRA不足以支付实际的净培训成本。研究人员提出了3条针对THCGME项目的建议：（1）使用支付公式每年对PRA进行通货膨胀调整，要明白这样的支付政策需要立法（拨款）和行政部门（实施）采取行动；（2）使用保持单一、固定支付且不根据THC特征进行调整的PRA；（3）鉴于支持数据有限，无法证明将额外成本分配给以健康中心为基础的培训是合理的，且考虑到其门诊环境，不为IME提供额外资金。
