The Cost of Third-Year Clerkships at Large Nonuniversity Teaching Hospitals

Background. —Large nonuniversity teaching hospitals are major providers of the clinical training component of undergraduate medical education, yet little information is available to policymakers, participating hospitals, or sponsoring medical schools on the institutional costs of this service. Objective. —To determine the costs associated with teaching students in required third-year clerkships for a group of large nonuniversity teaching hospitals. Setting/Participants. —A total of 201 medical students from nine large nonuniversity teaching hospitals affiliated with nine medical schools that participate in required third-year clerkships. Methods. —During a typical week, students completed 24-hour time and activity logs that classified each activity, instructor, and audience. From these logs, the number of teaching hours by full-time faculty and others were estimated and costs were calculated. Results. —Full-time faculty provided a mean of 0.242 h/d of formal teaching, 0.326 h/d of informal teaching, and 0.581 h/d of supervised patient care training per student, an estimated direct faculty cost of $412 per week per student. The cost of direct and indirect departmental and academic administration, as well as other direct out-of-pocket medical education costs, added $250 per week per student. The average annual clinical program cost of third-year clerkships to nonuniversity hospitals and their full-time faculties was $31 776 per student. This figure does not include the substantial contributions of teaching by other than paid faculty (eg, volunteer physicians and residents), which was important in terms of activity and service provided. Conclusions. —Direct and indirect costs of third-year medical student education for most hospitals in this study was more than $1 million per year, well in excess of the average support provided by sponsoring medical schools. ( JAMA . 1994;272:669-673)