1
|
Drezdzon MK, Cowley NJ, Sweeney DP, Peterson CY, Ridolfi TJ, Ludwig KA, Evans DB, Calata JF. Going for Broke: The Impact of Cost of Living on Surgery Resident Stipend Value. Ann Surg 2023; 278:1053-1059. [PMID: 37226808 DOI: 10.1097/sla.0000000000005923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to provide a direct comparison of first-year general surgery resident stipends across states and major cities, using the Cost-of-Living Index (COLI) to determine stipend value. BACKGROUND Financial challenges are among residents' top sources of stress, and this may be exacerbated in areas with high costs of living. A 2021 survey found that the mean first-year medical resident stipend increased by 0.6%, or $358, from 2020 to 2021, and only 33% of institutions used cost-of-living to determine annual resident stipend adjustments. METHODS An American Medical Association database was used to identify accredited general surgery residency programs. The 2021-2022 stipend data for first-year general surgery positions were obtained, then data were grouped by state and major city and averaged. Major cities were defined as cities with >4 programs.A direct comparison of stipends was performed using the COLI. RESULTS Stipend data were available for 337 of 346 general surgery programs. The national average first-year residency stipend was $60,064±$4233. The average COLI-adjusted stipend was $57,090±$5742, with a value loss of -$3493, or 5%.For major cities, the average stipend was $63,383±$4524, and the average COLI-adjusted stipend was $46,929±$8383, with an average value loss of -$16,454, or 26%. CONCLUSIONS The financial burdens that residents face cannot be overlooked, and the cost of living has a meaningful impact on resident stipend value. The current Graduate Medical Education compensation structure limits federal and institutional capacity to adjust for the cost of living and creates an insulated market in which residents are under-compensated.
Collapse
Affiliation(s)
| | | | | | - Carrie Y Peterson
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Ridolfi
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Kirk A Ludwig
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jed F Calata
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| |
Collapse
|
2
|
Alweis R, Donato A, Terry R, Goodermote C, Qadri F, Mayo R. Benefits of developing graduate medical education programs in community health systems. J Community Hosp Intern Med Perspect 2021; 11:569-575. [PMID: 34567443 PMCID: PMC8462840 DOI: 10.1080/20009666.2021.1961381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The creation of new CMS-funded Graduate Medical Education (GME) cap positions by the Consolidated Appropriations Act 2021 offers a unique opportunity for systems in community and rural settings to develop and expand their training programs. This article provides a review of the evidence behind the value proposition for system administrators to foster the growth of GME in community health systems. The infrastructure needed to accredit GME programs may reduce the cost of care for both the patients and the system through improved patient outcomes and facilitation of system efforts to recognize and mitigate social determinants of health. Residents, fellows and medical students expand the capacity of the current healthcare workforce of a system by providing coverage during healthcare emergencies and staffing services in difficult-to-recruit specialties. Those trainees are the nucleus of succession planning for the current medical staff, can facilitate the creation and expansion of service lines, and may elevate the profile of the system through scholarly work and equity and quality improvement activities. While creating GME programs in a community health system may, at first glance, be perceived as cost-prohibitive, there are robust advantages to a system for their creation.
Collapse
Affiliation(s)
- Richard Alweis
- Department of Medical Education, Rochester Regional Health, Rochester, New York, United States
| | - Anthony Donato
- Department of Medicine, Tower Health, West Reading, Pennsylvania, United States
| | - Richard Terry
- Academic Affairs, Lake Erie College of Medicine at Elmira, Elmira, New York, United States
| | - Christina Goodermote
- Department of Medical Education, Rochester Regional Health, Rochester, New York, United States
| | - Farrah Qadri
- Department of Medical Education, Rochester Regional Health, Rochester, New York, United States
| | - Robert Mayo
- Department of Medical Education, Rochester Regional Health, Rochester, New York, United States
| |
Collapse
|
3
|
He K, Whang E, Kristo G. Graduate medical education funding mechanisms, challenges, and solutions: A narrative review. Am J Surg 2021; 221:65-71. [PMID: 32680622 PMCID: PMC7308777 DOI: 10.1016/j.amjsurg.2020.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/30/2020] [Accepted: 06/06/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND With increased attention on the federal budget deficit, graduate medical education (GME) funding has in particular been targeted as a potential source of cost reduction. Reduced GME funding can further deteriorate the compensation of physicians during their residency training. METHODS In order to understand the GME funding mechanisms and current challenges, as well as the value of the work accomplished by residents, we searched peer-reviewed, English language studies published between 2000 and 2019. RESULTS Direct and indirect GME funding is intended to support resident reimbursement and the higher costs associated with supporting a teaching program. However, policy efforts have aimed to reduce federal funding for GME. Furthermore, evidence suggests that residents are inadequately compensated because their salaries do not reflect the number of hours worked and are not comparable to those of other medical staff. CONCLUSIONS Our review suggests that creative solutions are needed to diversify GME funding and improve resident compensation.
Collapse
Affiliation(s)
- Katherine He
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward Whang
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gentian Kristo
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
4
|
Shahlaie K, Harsh GR. Editorial. The financial value of a neurosurgery resident. J Neurosurg 2020; 135:164-168. [PMID: 32916648 DOI: 10.3171/2020.4.jns20836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
5
|
University Hospital Financial Status Does Not Influence Subjective Perception of General Surgery Residents on Training Adequacy. World J Surg 2020; 44:2495-2500. [PMID: 32246184 DOI: 10.1007/s00268-020-05500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgical residency training is a complex and costly task. Hospital economic health is dependent on different variables, but it is especially linked to the country macroeconomics that may be extremely fluctuating, especially in underdeveloped countries. This study analyzed the correlation between a single-center university hospital financial status and subjective perception of general surgery residents on program support and adequacy. METHODS We surveyed former residents that started general surgery residency program in a tertiary university hospital between 1999 and 2017. Individuals answered a questionnaire about the perception of the influence of the hospital´s financial status on training. Hospital´s financial status was estimated yearly by the current liquidity ratio (CLR) that measures whether or not a company has enough resources to meet its short-term obligations. RESULTS Two hundred and fifty-seven (96%) were still in surgical practice; 242 (93%) were satisfied with their residency training; 210 (78%) believed training was affected by financial status; 183 (68%) believed they were prepared for independent practice; 180 (67%) practiced in an academic environment; 146 (54%) felt the need to complete specialty training beyond residency; and 56 (21%) believed hospital financial status was adequate. The rate of positive or negative answers did not correlate with the current liquidity ratio, except for the need to complete specialty training that was indirectly related to CLR. CONCLUSIONS University hospital financial status did not influence subjective perception of general surgery residents on training, program support and adequacy.
Collapse
|
6
|
Myers JD, Arroliga AC, White BAA, Janek H, Wesson DE. The graduate medical educational enterprise. Proc AMIA Symp 2019; 32:449-451. [PMID: 31384219 DOI: 10.1080/08998280.2019.1588680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- John D Myers
- Department of Internal Medicine, Baylor Scott & White Health, Central DivisionTempleTexas.,Department of Internal Medicine, Texas A&M Health Science Center College of MedicineTempleTexas
| | - Alejandro C Arroliga
- Department of Internal Medicine, Baylor Scott & White Health, Central DivisionTempleTexas.,Department of Internal Medicine, Texas A&M Health Science Center College of MedicineTempleTexas
| | - Bobbie Ann Adair White
- Department of Humanities in Medicine, Texas A&M Health Science Center College of MedicineTempleTexas
| | - Hania Janek
- Department of Education, Baylor Scott & White HealthTempleTexas.,Department of Obstetrics & Gynecology and Internal Medicine, Texas A&M Health Science Center College of MedicineTempleTexas
| | - Donald E Wesson
- Department of Medicine, Baylor Scott & White Health and Wellness CenterDallasTexas.,Texas A&M Health Sciences Center College of MedicineDallasTexas
| |
Collapse
|
7
|
O'Callaghan J, Mohan HM, Sharrock A, Gokani V, Fitzgerald JE, Williams AP, Harries RL. Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland. BMJ Open 2017; 7:e018086. [PMID: 29146646 PMCID: PMC5695344 DOI: 10.1136/bmjopen-2017-018086] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Applications for surgical training have declined over the last decade, and anecdotally the costs of training at the expense of the surgical trainee are rising. We aimed to quantify the costs surgical trainees are expected to cover for postgraduate training. DESIGN Prospective, cross-sectional, questionnaire-based study. SETTING/PARTICIPANTS A non-mandatory online questionnaire for UK-based trainees was distributed nationally. A similar national questionnaire was distributed for Ireland, taking into account differences between the healthcare systems. Only fully completed responses were included. RESULTS There were 848 and 58 fully completed responses from doctors based in the UK and Ireland, respectively. Medical students in the UK reported a significant increase in debt on graduation by 55% from £17 892 (2000-2004) to £27 655 (2010-2014) (p<0.01). 41% of specialty trainees in the UK indicated that some or all of their study budget was used to fund mandatory regional teaching. By the end of training, a surgical trainee in the UK spends on average £9105 on courses, £5411 on conferences and £4185 on exams, not covered by training budget. Irish trainees report similarly high costs. Most trainees undertake a higher degree during their postgraduate training. The cost of achieving the mandatory requirements for completion of training ranges between £20 000 and £26 000 (dependent on specialty), except oral and maxillofacial surgery, which is considerably higher (£71 431). CONCLUSIONS Medical students are graduating with significantly larger debt than before. Surgical trainees achieve their educational requirements at substantial personal expenditure. To encourage graduates to pursue and remain in surgical training, urgent action is required to fund the mandatory requirements and annual training costs for completion of training and provide greater transparency to inform doctors of what their postgraduate training costs will be. This is necessary to increase diversity in surgery, reduce debt load and ensure surgery remains a popular career choice.
Collapse
|
8
|
Dafydd DA, Baskaradas A, Bobdiwala S, Anwar MS, Abrahams R, Jeremy L. Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis. Clin Med (Lond) 2016; 16:235-9. [PMID: 27251912 PMCID: PMC5922701 DOI: 10.7861/clinmedicine.16-3-235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective.
Collapse
Affiliation(s)
- Derfel Ap Dafydd
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Aroon Baskaradas
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Shabnam Bobdiwala
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
| | - Muhammad Saleem Anwar
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Rachel Abrahams
- Department of Postgraduate Medical Education, Imperial College Healthcare NHS Trust, London, UK
| | - Levy Jeremy
- Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
9
|
Stoller J, Pratt S, Stanek S, Zelenock G, Nazzal M. Financial Contribution of Residents When Billing as "Junior Associates" in the "Surgical Firm". JOURNAL OF SURGICAL EDUCATION 2016; 73:85-94. [PMID: 26684417 DOI: 10.1016/j.jsurg.2015.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/26/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE There is an increasing number of proposals to change the way Graduate Medical Education is funded. This study attempts to estimate the potential financial contribution of surgical residents using an alternative funding mechanism similar to that used by law firms, which would allow surgery departments to bill for resident activity as "junior associates." METHODS Following 24 residents over a period of 12 weeks, we were able to estimate the annual revenue that they generated from operating room procedures, independent consultations, patient management, and minor procedures using Medicare reimbursement rates. The appropriate first assistant modifier was used to calculate the operating room procedure fees, but full price was used to calculate the revenue for minor procedures, patient management, and consultations done independently. We adjusted for vacation time and academic activities. RESULTS Including postgraduate year 1 residents, the estimated yearly revenue generated per resident in first assistant operative services was $33,305.67. For minor procedures, patient management, and independent consultations, the estimated yearly revenue per resident was $37,350.66. The total estimated financial contribution per resident per year was $70,656.33. Excluding postgraduate year 1 residents, as most states require completion of the intern year before full licensure, the estimated yearly revenue generated per resident in first assistant operative services was $38,914.56. For minor procedures, patient management, and independent consultations, the estimated yearly revenue per resident was $55,957.33. The total estimated financial contribution per resident per year was $94,871.89. CONCLUSIONS Residents provide a significant service to hospitals. If resident activity was compensated at the level of supervised "junior associates" of a surgery department, more than 75% of the direct educational costs of training could be offset. Furthermore, we believe this value is underestimated. Given the foreseeable changes in Graduate Medical Education funding, it is imperative that alternative approaches for funding be explored.
Collapse
Affiliation(s)
- Jeremy Stoller
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Sarah Pratt
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Stephen Stanek
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Gerald Zelenock
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Munier Nazzal
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio.
| |
Collapse
|
10
|
Raines A, Garwe T, Adeseye A, Ruiz-Elizalde A, Churchill W, Tuggle D, Mantor C, Lees J. The Effects of the Addition of a Pediatric Surgery Fellow on the Operative Experience of the General Surgery Resident. Am Surg 2015. [DOI: 10.1177/000313481508100626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 ( P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 ( P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.
Collapse
Affiliation(s)
- Alexander Raines
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Tabitha Garwe
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
- Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Ademola Adeseye
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Warren Churchill
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - David Tuggle
- Department of Surgery, Section of Pediatric Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas
| | - Cameron Mantor
- Department of Biostatistics and Epidemiology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Jason Lees
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
11
|
Wild JRL, Fitzgerald JEF, Beamish AJ. Health Education England, Local Education and Training Boards (LETBs) and reform of healthcare education: implications for surgical training. BMC Surg 2015; 15:3. [PMID: 25592885 PMCID: PMC4324039 DOI: 10.1186/1471-2482-15-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background National Health Service (NHS) reforms have changed the structure of postgraduate healthcare education and training. With a Government mandate that promotes multi-professional education and training aligned with policy driven initiatives, this article highlights concerns over the impact that these changes may have on surgical training. Discussion The creation of Health Education England (HEE) and its local education and training boards (LETBs), which are dominated by NHS healthcare providers, should result in greater accountability of employers in workforce planning, enhanced local responsibility and increased transparency of funding allocation. However, these changes may also create a potential poacher-turned-gamekeeper role of employers, who now have responsibility for junior doctors’ training. Analysis of LETB membership reveals a dearth of representation of surgeons, who comprise only 2% of board members, with the input of trainees also seemingly overlooked. A lack of engagement with the LETBs by the independent sector is a concern with increasing numbers of training opportunities potentially being lost as a result. The new system also needs to recognise the specific training needs required by the craft specialties given the demands of technical skill acquisition, in particular regarding the provision of simulation training facilities and trainer recognition. However, training budget cuts may result in a disproportionate reduction of funding for surgical training. Surgical training posts will also be endangered, opportunities for out-of-programme experience and research may also decline and further costs are likely to be passed onto the trainee. Summary Although there are several facets to the recent reforms of the healthcare education and training system that have potential to improve surgical training, concerns need to be addressed. Engagement from the independent sector and further clarification on how the LETBs will be aligned with commissioning services are also required. Surgical training is in danger of taking a back seat to Government mandated priorities. Representation of trainees and surgeons on LETB committees is essential to ensure a surgical viewpoint so that the training needs of the future consultant workforce meet the demands of a 21st century health service.
Collapse
Affiliation(s)
- Jonathan R L Wild
- Association of Surgeons in Training, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom.
| | | | | |
Collapse
|