Editorials

Doctors in training: wasteful and inefficient?

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1107 (Published 11 April 1998) Cite this as: BMJ 1998;316:1107

Not if the training is properly structured and supervised

  1. Terrill K Rosborough, Director of medical education
  1. Abbott Northwestern Hospital, Minneapolis, MN 55407, USA

    The United States government seems almost certain to decrease funding for graduate medical education in teaching hospitals. At the same time competition in healthcare delivery is forcing hospitals to cut costs. If teaching medical graduates increases hospital costs and if trainees cause waste and inefficiency in patient care hospitals may choose to eliminate their teaching programmes. As hospitals throughout the developed world are being subjected to market pressures they need to know the contribution and the costs of training doctors. Is the widely held belief that doctors in training cause waste and inefficiency true?

    The costs of a graduate medical education programme include the salaries of trainees and their teachers, administrative support, space, supplies, and equipment. The programme for 30 residents in internal medicine at this hospital costs about $5m (£3.3m). In the United States the revenue for residency training programmes comes from several sources: the federal government's Medicare programme, income generated by the teaching faculty in patients' fees and research grants, and sometimes endowment funds. For our programme, the total revenue is about $6.5m (£4.3m), almost 90% of which comes from Medicare. The surplus is mainly due …

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