In his essay on the status of graduate surgical education, published in the October issue of the ARCHIVES (1998;133:1039-1040), McMillen, an experienced department chairman in 2 community-based academic medical centers, has discussed financial and regulatory challenges facing surgical residency programs in general and community-based programs in particular. It is useful to frame his observations in terms of expenses and costs. Dr McMillen has calculated that it will take 2.5 physician assistants to replace a single surgical resident. The extraordinary salary and benefit burden this change imposes on the hospital is an expense. There are many other effects of this action that represent costs to the institution, its patients, and ultimately our society.
Becker JM, Millham F. Surgical Residencies and Community Teaching Hospitals. Arch Surg. 1998;133(11):1255. doi: