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Training A Plastic Surgeon: The Cost Of Residency And Its Implications
Leen El Eter, BS, Kimberly H. Khoo, MPH, Scott D. Lifchez, MD, Damon S. Cooney, MD, PhD, Carisa M. Cooney, MPH.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE:
Developing and maintaining a surgical residency program entails significant financial obligations. The costs associated with plastic surgery residency training and accreditation by regulatory bodies are yet to be delineated. This study seeks to explore the costs associated with plastic surgery residency training as mandated by the American Council of Graduate Medical Education (ACGME) and the American Board of Plastic Surgery (ABPS). We aim to elucidate potential areas for improvement and innovation of funding resources to ensure the continuation and growth of proper plastic surgery training.
METHODS:Cost-associated mandates per the 2020 ACGME and ABPS booklet were identified. These costs were separated into labor, opportunity, and fixed costs. Calculations reflected the minimum cost of training two plastic surgery residents, which is an estimate of the average number of residents per year per program from 2017-2021, according to the National Residency Match Program Data. Salaries were based on data from the Association of American Medical Colleges. Relevant costs reflected data from our department and institution.
RESULTS: Our calculations demonstrated a minimum cost of $472,519 to train two residents per year in accordance with the ACGME and ABPS mandates, with an average cost of $236,260 per resident. This includes labor, opportunity, and fixed costs (Table 1). Labor costs totaled $279,560 with resident salary being the highest contributor ($128,000). Opportunity costs were the highest cost category at $176,529, of which the cost of grand rounds ($120,238) was the highest contributor. Fixed costs were the lowest ($16,430) with the highest contributor being ABPS-required costs for board certification ($8,490, Table 2). In order to reflect the financial spectrum between large and small programs, we adapted our calculations to estimate costs of one ($367,427) and five ($763,687) residents per year.
CONCLUSION: Training future plastic surgeons is associated with significant direct and indirect financial costs. Plastic surgery represents an essential field in healthcare, and we hope that by providing cost estimates for resident education, the medical community may continue to think creatively about alternative funding sources to ensure continued quality training that meets the nationís needs.


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