Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland

Abstract

ObjectivesApplications 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.DesignProspective, cross-sectional, questionnaire-based study.Setting/ParticipantsA 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.ResultsThere 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).ConclusionsMedical 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.

Relationship between sociodemographic factors and specialty destination of UK trainee doctors: a national cohort study

“…Finally, general practice training is much shorter than many other specialties and general practice trainees tend to work in one place rather than rotating around (often geographically dispersed) hospitals. This may mean fewer financial demands on trainees than other pathways54–56 and thus may appeal to more mature trainees/residents who are likely to have greater financial and domestic commitments than younger ones 57 58. A recent report looking at how doctors progress through postgraduate training also highlighted how mature and graduate entry trainees are concerned with getting through training as quickly as possible 59.…”

40-4-40: educational and economic outcomes of a free, international surgical training event

“…Of these trainees 78% reported graduating with debt, which has been reported as high as £81,916 at the point of graduation. Increasing costs of Royal College membership fees, Joint Committee for Surgical Training administration fees, courses, conferences and examinations have been mirrored by a decline in educational funding 6. It was demonstrated by ‘40-4-40’ that high-quality training can be provided without prohibitive costs to the trainee, in addition to providing a surplus for reinvestment in the charitable activity of the association.…”

Endovascular Training Using a Simulation Based Curriculum is Less Expensive than Training in the Hybrid Angiosuite

“…As surgical trainees already face increasing debt due to rising training costs, action is required to fund the mandatory requirements and training costs for surgical training. 35 The government could fund this program instead of financing random educational courses without showing a return on investment. 36 Improving surgical performance and reducing errors caused by training on real patients should be an investment highly prioritised by society.…”