Here is some math. and a source:
http://www.medpac.gov/documents/contractor-reports/sept13_residents_gme_contractor.pdf?sfvrsn=0
PA's gross full time. They don't have CP rotations. They don't do Autopsy. They don't do cytology. They don't sign out for hours a day. How many hours/day do residents gross? On a busy surgpath service, let's say 4 hrs/day. How many hardcore surgpath months does a resident even do in a given year? 4? How efficient is a resident at grossing compared to a PA who does it full time on average? 1/2 as good? less? How good is a 1st year resident at grossing compared to a 4th year? .25 of all residents are first years and suck at everything.
PLUS, residents burden faculty in the following ways:
1. "teach" pathology at the scope for hours/day that could be better served reviewing cases
2. giving lectures to residents, wasting time that could be better used signing out cases
3. serving in pointless academic administrative functions for residents, time that could be better utilized signing out cases
I would argue that, if a 4th year resident is as efficient at grossing as a PA, and the average resident is 1/2 as efficient as a PA; then using the math above 1 resident is worth 0.08 PA FTE for grossing. That means you need 12.5 residents to get the relative value of a PA.
Furthermore, you need to look into the total cost of hiring residents beyond salary. Don't forget your figures include fellow salaries as well. Medicare compensation for residents range depending on a lot of factors from 110,000- 150,000 depending on the size of the institution. $150K is not the mean. This money has to not only cover the resident and their benefits (average ~65K for salary, 25-50K benefits for primary care), but also:
- CME office, staff, overhead
- seminars, travel expenses
- space, supplies, equipment, support
- insurance
-... and most importantly, pay for the physicians for the lost work time and their training.
There is a lot to this and it's not simple... but from the Rand report linked above...
"Medicare covers about 23.5 percent of direct GME costs incurred by teaching hospitals (RAND analysis of FY 2010/2011 Medicare cost reports). Relative to the average per resident payment, payments are about 6 percent higher for residents in primary care specialties and about 14 percent lower for residents beyond their initial residency period."
If someone knows more detail, please feel to chime in, but my understanding is that Medicare will only pay $71K per resident (IME), provided the program is below its allotted "cap" (and $0 after) (the number above). Medicare DME pays additional funds, as so does medicaid. I don't know what this is for pathology. DME and medicaid appear to pay differently depending on a lot of factors... the details are here:
http://bhpr.hrsa.gov/childrenshospitalgme/pdf/paymentmethodology.pdf
Some hospitals appear to get more or less funding based on a lot of factors. Regardless, I have a difficult time believing that residency programs somehow benefit in any economic sense from having residents. With a staff of 20 faculty working 50% service time, assuming the staff could sign out 10 more biopsies per day without having any residents to slow them down(which is pretty conservative), they could bill an extra $2.6M per year. If they have to hire a PA at $85K, that's still a pretty good reason to NOT take residents. A department that size would probably have 4-5 residents. The net gain from "CMS" would be $50K per resident at best, assuming the costs beyond compensation are negligible (which they are not), so in this case the department leaves well over $1M on the table (plus a PA) to "take" $200K from the government.
Sorry for the wall of text. I welcome well-reasoned responses and arguments.
