Z. C. Dietch1,2, S. E. Bodily2, B. Schirmer1, R. Sawyer1 1University Of Virginia,Department Of Surgery,Charlottesville, VA, USA 2University Of Virginia,Darden School Of Business,Charlottesville, VA, USA
Introduction: Two years of dedicated time for research (DTR) has been a fixture of traditional academic general surgery training programs. However, concerns with the current format for general surgery training and the declining availability of research funding have prompted debate about the appropriate role of DTR during residency. In particular, longer training raises costs to residents, who forgo the earning potential of attending surgeons by extending the duration of training. We hypothesized that DTR during surgical residency represents a large opportunity cost for a general surgeon’s total expected lifetime wealth (ELW).
Methods: A pro-forma financial model for a general surgeon’s ELW was developed to simulate annual earnings from age 18 through 65, accounting for the costs of undergraduate education, medical school, earnings during residency, earnings following training, pre-tax and after-tax savings, and taxes. Expected annual inflation and annual returns on investment were accounted for using mean-reverting models developed with historic inflation and market performance data. Monte Carlo simulation was performed using Crystal Ball (Oracle, Fusion Edition) to conduct 10,000 trials per scenario. Base-case and alternative scenarios were constructed to model the effects of five-year (FY) and seven-year (SY) training programs on ELW. Sensitivity analysis determined that the incremental difference in ELW was sensitive to real wage growth and ELW were assessed under different scenarios of annual real wage growth.
Results: In the FY model with 0% annual real wage growth, mean ELW totaled $11.52 million after adjusting for inflation. In the SY model, mean ELW was reduced by $728,768 (95% CI $(2,197,154)-$(310,617)) to $10.79 million, representing a reduction of 6.33% of ELW. Sensitivity analyses demonstrate that negative real wage growth increases the relative opportunity cost of dedicated research time (Table).
Conclusion: Trainees who extend surgical training to complete dedicated time for research may incur a significant opportunity cost and reduction in ELW. The percentage magnitude of this cost is exacerbated by real wage decline. Medical students and surgical trainees should understand the financial sacrifices associated with SY versus FY training. Given the financial implications of DTR, trainees would be best served by utilizing DTR only when it directly supports career aspirations, such as a career in academic surgery. Residency program leadership and surgical training governing organizations should consider structural reforms to training programs to ensure that the timing and nature of DTR better align with the career goals of individual trainees.
