Strides in Development of Medical Education

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Actual Costs of Residency Training in Teaching Hospitals: A Case of Iran

Document Type : Original Article

Authors

1 Department of Health Economics, School of Health Management and Information Science, Health Management and Economics Research Center, Iran University of Medical Science, Tehran, Iran

2 Associate Professor, Department of Anesthesiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Associate Professor, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

4 Assistant Professor, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

5 Ph.D. Student in Policy and Policy Management, Director of Finance, Iran University of Medical Sciences, Tehran, Iran

6 Assistant Professor, Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran

7 Ph.D. Student in Heath Policy, Health Management and Economics Research Center Iran University of Medical Sciences, Tehran, Iran

8 Ph.D. Student of Financial Management, Head of Affairs, Endocrine Research Center, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: There was a challenge for teaching hospitals to accept residents for educational goals due to their training costs.
Objectives: The present study aimed to estimate the actual costs of residency training in hospitals for policymaking, budgetary impact, and negotiation.
Methods: This retrospective study was performed in eight teaching hospitals affiliated with the Iran University of Medical Sciences, Tehran, Iran, in 2018. Two scenarios were designed to estimate the costs of education per resident. All of the resources used by residents in the hospitals were identified. Cost items attributed to the training goals were allocated to the internal medicine and surgical fields; however, for cost items that were used for treatment and education, such as disposables and consumables and equipment, the cost drivers were used. Therefore, the difference between the scenarios was related to the cost drivers.
Results: Overall, the selected hospitals had spent $ 586,720.35 and $ 572,358.10 based on scenarios 1 and 2, respectively. The residency training per surgical resident in the hospitals was about 1.2 times higher than an internal medicine resident. Surgery, neurology, urology, and anesthesiology were the fields with the highest costs in the hospitals.
Conclusion: Although residency training accounts for a large proportion of hospital costs, employing residents reduces the costs of human resources. Monitoring and controlling costs, as well as resource quotas for resident training, can be a way to reduce educational course costs in hospitals. Universities can cover some parts of the educational costs to motivate hospitals to make an appropriate setting for residents.

Keywords

References
  1. Fitzgerald J, Ravindra P, Lepore M, Armstrong A, Bhangu A, Maxwell-Armstrong C. Financial impact of surgical training on hospital economics: an income analysis of 1184 out-patient clinic consultations. Int J Surg. 2013;11(5):378-82. doi: 10.1016/j.ijsu.2013.02.017. [PMID: 23459186].
  2. Walsh K. Cost and value in medical education–what we can learn from the past? J R Coll Physicians Edinb. 2014;44(4):324-7. doi: 10.4997/jrcpe.2014.417. [PMID: 25516905].
  3. Waters KP, Mazivila ME, Dgedge M, Necochea E, Manharlal D, Zuber A, et al. eSIP-Saúde: Mozambique’s novel approach for a sustainable human resources for health information system. Hum Resour Health. 2016 Nov 5;14(1):66. doi: 10.1186/s12960-016-0159-y. [PMID: 27814734]. [PMCID: PMC5097348].
  4. Waters KP, Zuber A, Simbini T, Bangani Z, Krishnamurthy RS. Zimbabwe’s Human Resources for health Information System (ZHRIS)—an assessment in the context of establishing a global standard. Int J Med Inform. 2017 Apr;100:121-8. doi: 10.1016/j.ijmedinf.2017.01.011. [PMID: 28241933].
  5. Da’ar OB, Alshaya A. Is it cost-beneficial to society? Measuring the economic worth of dental residency training. Eval Program Plann. 2018 Jun;68:117-123. doi: 10.1016/j.evalprogplan.2018.02.012. [PMID: 29549781].
  6. Gray JD. Global rating scales in residency education. Acad Med. 1996 Jan;71(1 Suppl):S55-63. doi: 10.1097/00001888-199601000-00043. [PMID: 8546784].
  7. Goodson JD. Physician training outside the hospital: who pays for the future? Ann Intern Med. 1987 Sep;107(3):415-7. doi: 10.7326/0003-4819-107-2-415. [PMID: 3619227].
  8. Nikonow TN, Lyon TD, Jackman SV, Averch TD. Survey of applicant experience and cost in the urology match: opportunities for reform. J Urol. 2015 Oct;194(4):1063-7. doi: 10.1016/j.juro.2015.04.074. [PMID: 25912495].
  9. Kane RL, Bershadsky B, Weinert C, Huntington S, Riley W, Bershadsky J, et al. Estimating the patient care costs of teaching in a teaching hospital. Am J Med. 2005 Jul;118(7):767-72. doi: 10.1016/j.amjmed.2005.02.011. [PMID: 15989911].
  10. Edwardson N, Bolin JN, McClellan DA, Nash PP, Helduser JW. The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs. Prev Med. 2016 Apr;85:98-105. doi: 10.1016/j.ypmed.2016.02.007. [PMID: 26872393].
  11. Rozenshtein A, Gilet AG, Griffith B, Kamran A, Wiggins III EF, Anderson JC. Radiology residency match: the cost of being in the dark. Acad Radiol. 2018 Nov;25(11):1491-1496. doi: 10.1016/j.acra.2018.04.022. [PMID: 29941399].
  12. Huang WW, Feldman SR. The cost of applying to dermatology residency. J Am Acad Dermatol. 2016 Apr;74(4):775-6. doi: 10.1016/j.jaad.2015.12.032. [PMID: 26979363].
  13. Tolsgaard MG, Tabor A, Madsen ME, Wulff CB, Dyre L, Ringsted C, et al. Linking quality of care and training costs: cost‐effectiveness in health professions education. Med Educ. 2015 Dec;49(12):1263-71. doi: 10.1111/medu.12882. [PMID: 26611191]. [PMCID: PMC5063180].
  14. Zeidel ML, Kroboth F, McDermot S, Mehalic M, Clayton CP, Rich EC, et al. Estimating the cost to departments of medicine of training residents and fellows: a collaborative analysis. Am J Med. 2005 May;118(5):557-64. doi: 10.1016/j.amjmed.2005.02.025. [PMID: 15866261].
  15. Oates RK, Goulston KJ. The hidden cost of medical student education: an exploratory study. Aust Health Rev. 2013 May;37(2):185-8. doi: 10.1071/AH12151. [PMID: 23237477].
  16. Ghasempour S, Rahimniya R, Rajabnezhad Z, Dargahi H. Calculating the Final Cost of Student Training by Activity Based Costing in School of Allied Medicine, Tehran University of Medical Sciences. Payavard. 2016; 10 (1) :104-18. [In Persian]
  17. Esmaeili R, Kianmehr M, Tahanzade AR, Ehtiati M, Ghorbani A, Pourfatemi A, et al. Calculating the unit cost of student training at Gonabad University of Medical Sciences in 2017: Using a step-down method. Teb va Tazkiye. 2018;27(2): 169-78. [In Persian]
  18. Central Bank of the Islamic Republic of Iran, Statistics, Foren Exchange Rtae, [cited 2018 Mar 8].Available from: URL: https://www.cbi.ir/exrates/rates_fa.aspx.
  19. Rakesh Verma, Shakti Kumar Gupta, Sidhartha Satpathy, Sunil Kant, Sunil Chumber, Deka R. Determination of the Cost of Training of Undergraduate Medical (MBBS) Student at All India Institute of Medical Sciences, New Delhi, India. Int J Res Foundation Hosp Healthc Adm. 2013;1(1):1-7. doi:10.5005/jp-journals-10035-1001.
  20. Franzini L, Low MD, Proll MA. Using a cost-construction model to assess the cost of educating undergraduate medical students at the University of Texas--Houston Medical School. Academic Medicine: Journal of the Association of American Medical Colleges. 1997;72(3):228-37. doi: 10.1097/00001888-199703000-00018. [PMID: 9075427].
  21. Koenig L, Dobson A, Ho S, Siegel JM, Blumenthal D, Weissman JS. Estimating the mission-related costs of teaching hospitals. Health Aff (Millwood). Nov-Dec 2003;22(6):112-22. doi: 10.1377/hlthaff.22.6.112. [PMID: 14649437].
  22. Ben-Ari R, Robbins RJ, Pindiprolu S, Goldman A, Parsons PE. The costs of training internal medicine residents in the United States. Am J Med. 2014 Oct;127(10):1017-23. doi: 10.1016/j.amjmed.2014.06.040. [PMID: 25063649].
  23. Khuri SF, Najjar SF, Daley J, Krasnicka B, Hossain M, Henderson WG, et al. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg. 2001 Sep;234(3):370-82; discussion 382-3. doi: 10.1097/00000658-200109000-00011. [PMID: 11524590]. [PMCID: PMC1422028].
  24. Iezzoni LI, Shwartz M, Moskowitz MA, Ash AS, Sawitz E, Burnside S. Illness severity and costs of admissions at teaching and nonteaching hospitals. JAMA. 1990 Sep 19;264(11):1426-31. doi:10.1001/jama.264.11.1426. [PMID:2391739].
  25. Babineau TJ, Becker J, Gibbons G, Sentovich S, Hess D, Robertson S, et al. The cost of operative training for surgical residents. Arch Surg. 2004 Apr;139(4):366-9; discussion 369-70. doi: 10.1001/archsurg.139.4.366. [PMID: 15078701].
Strides in Development of Medical Education
Volume 18, Issue 1
December 2021
Pages 1-8
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