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

INTERNATIONAL JOURNAL OF SURGERY

卷:11

Article

Fitzgerald, J. E. F.¹  Ravindra, P.²  Lepore, M.³  Armstrong, A.⁴  Bhangu, A.⁵  Maxwell-Armstrong, C. A.⁶ 

[1] Chelsea & Westminster NHS Hosp Trust, London SW10 9NH, England

[2] Lincoln Cty Hosp, Dept Gen Surg, Lincoln LN2 5QY, Lincs, England

[3] Univ London Imperial Coll Sci Technol & Med, London SW7 2AZ, England

[4] Royal Devon & Exeter Hosp, Exeter EX1 2ED, Devon, England

[5] Gen Surg Specialist Trainee Rotat, Birmingham, W Midlands, England

[6] Univ Nottingham Hosp, Dept Gastrointestinal Surg, Nottingham NG7 2UH, England

关键词: Surgery;    Medical education;    Training;    Economics;    Costs;   

DOI  :  10.1016/j.ijsu.2013.02.017

来源: Elsevier

【 摘 要 】

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 outpatient 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 pound 218,712 ((sic)EU 266,527; $USD 353,657) generated by 6 surgical trainees (Residents). This is equivalent to approximately GBP pound 36,452 ((sic)EU 44,415; $USD 58,943) per trainee annually compared to GBP pound 48,732 ((sic)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. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

Free