Financial Value Analysis of Surgical Residency Programs: An Argument Against Replacement

Objective: To quantify the replacement cost of patient care provided by surgical residents and build a Graduate Medical Education (GME) value analysis model.

Design: Our Graduate Medical Education Executive Steering Committee designed a resident replacement cost model, based on patient care hours (adjusted for educational activities and a clinical efficiency factor, differential cost of faculty supervision for residents vs. APPs, and current program financials (revenue minus expenses). Strategic value planning included: academic productivity (local and national conference presentations, book chapters and publications and Senior Staff recruitment and retention.

Setting: Department of Surgery at Baylor Scott & White Medical Center, a tertiary institution located in Temple, TX.

Participants: Our replacement model was applied to a sample 30-position residency program.

Results: Modeling a 30-position residency program, replacement cost approaches 4.5 million dollars, based on a 1:3 Senior Staff-to-APP replacement ratio. A complete APP replacement complement has a projected cost of 3.1 million dollars, while replacement with Senior Staff approaches 9 million dollars.

Conclusions: We present a novel model for residency value analysis allowing for reproducible and standardized results across multiple residency programs. Challenges inherent to GME, such as clinical efficiency and the cost of faculty supervision, are accounted for. Quantifying resident replacement cost and financial value is a powerful tool when discussing institutional workforce planning within the current financial climate of healthcare.