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Abstract
Objectives Applications for surgical training have declined over the last decade, and anecdotally the costs of training at the expense of the surgical trainee are rising. We aimed to quantify the costs surgical trainees are expected to cover for postgraduate training.
Design Prospective, cross-sectional, questionnaire-based study.
Setting/Participants A non-mandatory online questionnaire for UK-based trainees was distributed nationally. A similar national questionnaire was distributed for Ireland, taking into account differences between the healthcare systems. Only fully completed responses were included.
Results There were 848 and 58 fully completed responses from doctors based in the UK and Ireland, respectively. Medical students in the UK reported a significant increase in debt on graduation by 55% from £17 892 (2000–2004) to £27 655 (2010–2014) (p<0.01). 41% of specialty trainees in the UK indicated that some or all of their study budget was used to fund mandatory regional teaching. By the end of training, a surgical trainee in the UK spends on average £9105 on courses, £5411 on conferences and £4185 on exams, not covered by training budget. Irish trainees report similarly high costs. Most trainees undertake a higher degree during their postgraduate training. The cost of achieving the mandatory requirements for completion of training ranges between £20 000 and £26 000 (dependent on specialty), except oral and maxillofacial surgery, which is considerably higher (£71 431).
Conclusions Medical students are graduating with significantly larger debt than before. Surgical trainees achieve their educational requirements at substantial personal expenditure. To encourage graduates to pursue and remain in surgical training, urgent action is required to fund the mandatory requirements and annual training costs for completion of training and provide greater transparency to inform doctors of what their postgraduate training costs will be. This is necessary to increase diversity in surgery, reduce debt load and ensure surgery remains a popular career choice.
- surgery
- health economics
- surgical training
- cost of training
- surgical education
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Footnotes
Contributors RLH and JEF conceived the study. All authors designed the questionnaire. JOC collected the data. JOC, HMM and RLH analysed the data. All authors were responsible for compiling and editing the manuscript, and approving the final article.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests The authors are either current or previous surgical trainees, and current or past elected members of the Council of the Association of Surgeons in Training (registered charity no 274841). JEF is an employee of KPMG Global Health Practice, honorary clinical advisor to the Lifebox Foundation Charity and a trustee of the SURG Foundation Research Charity. The authors have no other relevant financial or personal conflicts of interest to declare in relation to this paper.
Ethics approval The ethical dimensions of this non-mandatory, anonymous evaluation survey were considered and no concerns were identified.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Summary data are available from the corresponding author at president@asit.org. Consent to data sharing was sought prior to survey completion, and the presented data are anonymised grouped, hence risk of individual identification is low.