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. Epub 2013 Feb 28.


Introduction: In many countries healthcare commissioning bodies (state or insurance-based) reimburse hospitals for their activity. The costs associated with post-graduate clinical training as part of this are poorly understood. This study quantified the financial revenue generated by surgical trainees in the out-patient clinic setting.

Methods: A retrospective analysis of surgical out-patient ambulatory care appointments under 6 full-time equivalent Consultants (Attendings) in one hospital over 2 months. Clinic attendance lists were generated from the Patient Access System. Appointments were categorised as: 'new', 'review' or 'procedure' as per the Department of Health Payment by Results (PbR) Outpatient Tariff (Outpatient Treatment Function Code 104; Outpatient Procedure Code OPRSI1).

Results: During the study period 78 clinics offered 1184 appointments; 133 of these were not attended (11.2%). Of those attended 1029 had sufficient detail for analysis (98%). 261 (25.4%) patients were seen by a trainee. Applying PbR reimbursement criteria to these gave a projected annual income of £GBP 218,712 (€EU 266,527; $USD 353,657) generated by 6 surgical trainees (Residents). This is equivalent to approximately £GBP 36,452 (€EU 44,415; $USD 58,943) per trainee annually compared to £GBP 48,732 (€EU 59,378; $USD 78,800) per Consultant. This projected yearly income off-set 95% of the trainee's basic salary.

Conclusion: Surgical trainees generated a quarter of the out-patient clinic activity related income in this study, with each trainee producing three-quarters of that generated by a Consultant. This offers considerable commercial value to hospitals. Although this must offset productivity differences and overall running costs, training bodies should ensure hospitals offer an appropriate return. In a competitive market hospitals could be invited to compete for trainees, with preference given to those providing excellence in training.

MeSH terms

  • Appointments and Schedules
  • Costs and Cost Analysis
  • Economics, Hospital*
  • General Surgery / education*
  • Health Personnel / economics*
  • Health Personnel / organization & administration
  • Health Personnel / statistics & numerical data
  • Humans
  • Outpatient Clinics, Hospital / economics*
  • Referral and Consultation / economics*
  • Referral and Consultation / organization & administration
  • Retrospective Studies