Authors
Lorenzo Hiraldo, Tyler Zander, Rachel L Wolansky, Joseph Sujka, Bruce Hall, Marshall S Baker, Paul C Kuo
Published in
Surgery. Pages 110677. Sep 23, 2026. Epub Sep 23, 2026.
Abstract
Graduate medical education funding ($21 billion, fiscal year 2023) consists of direct graduate medical education and indirect medical education payments for resident training and infrastructure costs. Whether this funding impacts hospital quality remains unclear. We hypothesized that increased indirect medical education and direct graduate medical education funding per resident would be associated with improved hospital quality.
We analyzed 881 teaching hospitals from 2018 to 2023 using Centers for Medicare and Medicaid Services Hospital Compare and Graham Center databases.
Centers for Medicare and Medicaid Services 5-star rating, safety, mortality, health care-associated infections, and Medicare spending per beneficiary. Primary predictors include indirect medical education and direct graduate medical education dollars per resident, analyzed continuously. Multivariable regression adjusted for hospital size, resident volume, region, ownership, emergency services, structural confounders (case-mix index, Medicare discharge volume, and safety-net structure), and year. Hospital fixed-effects models were estimated.
Analysis included 4,418 hospital-years. Median total graduate medical education funding was $12.5 million per hospital-year in real 2023 dollars, with median total funding of $188,139 per resident. Adjusted for hospital characteristics, higher indirect medical education per resident was associated with better star rating, mortality, safety, and health care-associated infection performance (all P ≤ .03). After adding structural confounders, no independent association with indirect medical education per resident persisted, and none persisted within hospitals over time. Medicare discharge volume attenuated the star-rating association to null and reduced the remaining associations by 53%-75%. Documented resident wage costs did not increase while receipts approximately doubled.
Higher graduate medical education funding per resident was not independently associated with better hospital quality. Available data cannot determine how these funds are used; therefore, transparent reporting is required to evaluate this investment.
PMID:
42875263
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.
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