Earlier quoted context omitted.
What I said especially holds true if you are billing in the name of the attending. If you have residents doing real work and the attending checks it out, that shows up as $0 on the books for the resident, and potentially millions of billable services for the attending. When the hospital says, "we lose money on residents", of course they do! They way they bill ensures exactly that. That's why I say that step 1 is dete…
You're just hand waving and haven't proposed any sort of viable specific solution. Customers aren't willing to pay higher bills for the sake of training residents. Those who have a choice will go to a cheaper, non-teaching hospital. Hence the free rider problem.
We dont even agree that residents drive up costs. I dont agree that is a given.
If we assume residents are a cost, the solution is still simple. you just attach the cost of training to the physicians salary. Then, whatever hospital they work at will have pay for the training.
Last, the residency program costs are tinny in comparison to overall physician costs. Back of the envelope math shows the 20 billion program is a few percent physician costs, which are themselves only a part of healthcare costs.