Minimum instructional and program-specific administrative costs of educating residents in internal medicine

Background: The cost associated with education of residents is of interest from an educational as well as a political perspective. Most studies report a single institution's actual incurred costs, based on traditional cost ac counting methods. We quantified the minimum instructional and program-speci fic administrative costs for residency training in internal medicine. Methods: Using the Accreditation Council for Graduate Medical Education pro gram requirements for internal medicine as minimum standards for teaching a nd administrative effort, we quantified the minimum instructional and admin istrative costs for sponsorship of an accredited residency program in inter nal medicine. We also analyzed the impact of resident complement and progra m curricular emphasis (outpatient, inpatient, or traditional) on the per-re sident cost. The main outcome measure was the minimum annual per-resident c ost of instruction and program-specific administration. Results: Using the assumptions in this model, we estimated the annual cost per resident of implementing the program requirements to be $50648, $35477, $28517, and $26197 for inpatient intensive residency programs with residen t complements of 21, 42, 84, and 126, respectively. For outpatient intensiv e residency programs of identical resident complements, we estimated the an nual per-resident cost to be $58025, $42853, $35894, and $33574 for similar resident complements. Fixed costs mandated by the program requirements, wh ich did not vary across program size or configuration, were estimated to be $640737. Conclusions: There are fixed and variable costs associated with sponsorship of accredited internal medicine residency programs. The minimum cost per r esident of education and departmental administration varies inversely with program size within the sizes examined.