title: Financial impact of surgical training on hospital economics: an income analysis of 1184 out-patient clinic consultations.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: Chelsea & Westminster NHS Hospital Trust, 369 Fulham Road, London SW10 9NH, United Kingdom. edwardfitzgerald@doctors.org.uk
authors: J E F
authors: JE
authors: Fitzgerald
authors: P
authors: P
authors: Ravindra
authors: M
authors: M
authors: Lepore
authors: A
authors: A
authors: Armstrong
authors: A
authors: A
authors: Bhangu
authors: C A
authors: CA
authors: Maxwell-Armstrong
mesh_terms: D001071:Appointments and Schedules; D003365:Costs and Cost Analysis; D004469:Economics, Hospital; D013502:General Surgery / Q000193:education*; D006282:Health Personnel / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics* / Q000458:organization & administration; D012189:Retrospective Studies