The present analyses of different surgical training systems show that training of surgical residents significantly contributes to hospital costs. These are predominantly caused by prolonged operation times of residents with increased work load for other staff members in the operating room. In addition, the productivity of surgical residents is less compared to experienced surgeons. On the other hand, hospital managements save money by the lower standard wages paid to the residents. The amount of educational costs is difficult to determine because surgical training takes place as on the job training. Therefore, from an economic point of view, the two products patient care and surgical training are difficult to separate. There are no reliable cost analyses available for the German training system. At present surgical training is indirectly financed by the DRG (diagnosis-related groups) flat rates of the health insurance. Possible options of financing the surgical training are additional funding from the health department or redistribution with supplemental payment for those surgical departments which contribute significantly more to the residents' training. Statements of medical associations, health departments and health insurances demonstrate the difficulty to come to an agreement concerning the finances of the training system. Despite this controversial discussion it should be taken into consideration that there is no alternative to a high quality surgical training as this is the basis for an effective health system.