Financial impact of surgical training on hospital economics: An income analysis of 1184 out-patient clinic consultations

Fitzgerald, J Edward; Ravindra, Prithvishree; Lepore, Mario; Armstrong, April W.; Bhangu, Aneel; Maxwell-Armstrong, Charles

doi:10.1016/j.ijsu.2013.02.017

Cited by 11 publications

(10 citation statements)

References 25 publications

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“…Two UK-based studies have sought to quantify this within surgical training. 24 25 In general surgery, an analysis of 1184 outpatient clinic consultations demonstrated that trainees delivered a quarter of all outpatient-related income, averaging £36 452 per trainee. 24 This was sufficient to offset 95% of the trainees’ average basic salaries.…”

Section: Discussionmentioning

confidence: 99%

“… 24 25 In general surgery, an analysis of 1184 outpatient clinic consultations demonstrated that trainees delivered a quarter of all outpatient-related income, averaging £36 452 per trainee. 24 This was sufficient to offset 95% of the trainees’ average basic salaries. Within otolaryngology surgery, clinical activity undertaken by senior house officer (SHO) or core surgical trainee level grade doctors was calculated to generate an annual net income of £73 048 (4.3 times higher than their employment costs).…”

Section: Discussionmentioning

confidence: 99%

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

O’Callaghan

Sharrock

et al. 2017

BMJ Open

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

O’Callaghan

Sharrock

et al. 2017

BMJ Open

View full text Add to dashboard Cite

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“…1 A separate income analysis of 1,000 surgical outpatient consultations concluded that trainees potentially provide good value to their hospitals because their incomegenerating activity should more than offset the cost of followup appointments. 12 Furthermore, follow-ups are now being restricted by both clinical commissioners and trusts, with strict criteria and protocols to manage ongoing patient care. An audit of 848 outpatient oncology consultations performed elsewhere showed no difference in consultation duration between consultants and specialist registrars.…”

Section: Resultsmentioning

confidence: 99%

Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis

et al. 2016

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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.

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“…Trainee productivity contributes significantly to the healthcare service income and has been estimated to earn NHS Trusts far more than trainees’ salaries cost, with relatively little education and training commitment in return from the employer [ 22 ]. Despite this, there is concern that cuts to the MPET budget and a drive for multi-professional education and training will result in a disproportionate reduction of funding for medical education and training.…”

Section: Discussionmentioning

confidence: 99%

Health Education England, Local Education and Training Boards (LETBs) and reform of healthcare education: implications for surgical training

2015

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BackgroundNational 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.DiscussionThe 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.SummaryAlthough 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.

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Financial impact of surgical training on hospital economics: An income analysis of 1184 out-patient clinic consultations

Cited by 11 publications

References 25 publications

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

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

Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis

Health Education England, Local Education and Training Boards (LETBs) and reform of healthcare education: implications for surgical training

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