The Net Costs of Medical Training

27 Pages Posted: 14 Apr 2008

See all articles by Pedro P. Barros

Pedro P. Barros

Universidade Nova de Lisboa

Sara R. Machado

London School of Economics & Political Science (LSE)

Ana Maria Simões

affiliation not provided to SSRN

Date Written: April 13, 2008


One of the stages of medical training is the internship, where doctors-to-be (interns) face the real world of medical practice for the first time, under the supervision of a graduated physician. According to the career choice, the internship takes place at a provider of primary or secondary care. Hosting institutions often claim compensation for the training provided. The goal of this study is to identify the impact of the presence of the interns on the costs of providing care by the hosting institutions.

We contribute by jointly considering several important effects. On the one hand, interns are a fixed exogenous factor on the beginning of their learning curve, taking extra time and resources from both the hosting institution and the supervisor. On the other hand, interns can be regarded as a less expensive substitute to nurses and/or graduate physicians, in the production of health care, both in primary care centres and hospitals. Therefore, interns are a specific input that hosting institutions take into account when organizing health care delivery. The net effect can be either positive or negative. The data used comes from Portuguese primary care centres and hospitals. Regression analysis was used to estimate their impact on the cost structure. The results point out to a negligible impact of the interns in the total cost structure of primary care hosting institutions. In the case of hospitals, the presence of interns represents an extra cost to the institution, above the yearly wage. Furthermore, there is a positive relation between dimension and cost to the hospital. Therefore, net training costs (defined as the costs incurred by the hosting institution above the wage paid) seem to be largely compensated by the activity performed by interns, and training compensations, over and above the interns salary should be relatively minor.

Keywords: costs of medical training, hospitals, primary care centres

JEL Classification: I12, I18

Suggested Citation

Pita Barros, Pedro Luis and Machado, Sara R. and Simões, Ana Maria, The Net Costs of Medical Training (April 13, 2008). Available at SSRN: or

Pedro Luis Pita Barros (Contact Author)

Universidade Nova de Lisboa ( email )

Campus de Carcavelos
Rua da Holanda, 1
Carcavelos, 2775-405
+351 21 383 3624 (Phone)
+351 21 388 6073 (Fax)


Sara R. Machado

London School of Economics & Political Science (LSE) ( email )

Houghton Street
London, WC2A 2AE
United Kingdom

Ana Maria Simões

affiliation not provided to SSRN ( email )

No Address Available

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