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—Dr Sperry is correct in noting that we used average costs rather than marginal costs in our discussion of replacement costs for teaching at nonuniversity hospitals.Marginal costs seemed inappropriate for at least two reasons. First, many university hospitals could not accommodate all of the medical students, particularly in obstetrics and pediatrics. Other locations with attendant new administrative costs would be sought. Second, much of the teaching of third-year medical students is in very small groups. For example, the highest mean daily hours was for supervising students in the outpatient setting. In this situation the teacher-to-student ratio was only 1 to 21. It would be false to assume that the university faculty would simply absorb the new students without adding faculty costs. The latter represent almost two thirds of the costs in our study. It is certainly true that there is inequality of cost structures in different centers,
Weinberg E, O'Sullivan P. Cost of Teaching Medical Students-Reply. JAMA. 1995;273(10):771-772. doi:10.1001/jama.1995.03520340025016