AFAICT, way back in the day hospitals and clinics did residencies out of a desire for free/cheap labor, the same reason that some firms provide internships in other fields today. Nowadays the costs and obligations of providing a residency far exceed the benefits of the lower cost labor.
I really don’t understand how the average resident could be a cost center for a hospital. At least over the course of their 4-6+ years.
There are some hospitals you will go to (big names!) where you will never actually see an attending physician most of the time. Your entire care team are residents.
How a hospital can’t turn a profit off $60k/yr “junior doctors” doing all the actual work is beyond me. I’m sure there are costs I am not considering, but my immediate gut reaction is that it’s nearly all creative accounting to pretend residents cost more than they bring in - to keep that sweet government subsidy coming in as well as limiting the number of slots.
Some programs of course this makes sense, but on the whole it doesn’t seem to pass a smell test to me.
For the math to work, the fully qualified attending would have to be ~10x more efficient than the residents ($600k salary vs $60k salary - very rough, obv).
The current state seems to be "a single attending is more efficient practicing solo than the same attending overseeing five residents"
Some of this is an internal accounting problem. The net income (or loss) from operating a residency program depends on how you allocate associated revenues and fixed costs to it. But empirically the fact that teaching hospitals aren't all rushing to expand their residency programs indicates that they probably aren't profitable.
The value of residents varies a lot by experience and specialty. Like a 1st-year neurosurgery resident might be worse than useless and a huge burden to everyone around them. Whereas a 3rd-year family medicine resident can do a lot with minimal supervision.
Perhaps, then, those who have graduated into practice and who are now earning big bucks ought to absorb part of the cost. For example, training residents at some reasonable frequency could become a requirement of license renewal.
Not all physicians live and work near a teaching hospital where residents are trained. This isn't something that can be done just anywhere. And not everyone makes a good teacher; forcing people to teach who don't want to do it will guarantee bad results.
