BOX 4-1

Costs of Health Professional Education

Depending on the method used, the number of advanced practice registered nurses (APRNs) that can be trained for the cost of training 1 physician is between 3 and 14. Assessing the costs of education is a multidimensional problem. Manno (1998) has suggested that costs for higher education can be measured in at least four ways:

  • “the production cost of delivering education to students;

  • the ‘sticker price’ that students/families are asked to pay;

  • the cost to students to attend college, including room and board, books and supplies, transportation, tuition, and fees; and

  • the net price paid by students after financial aid awards” (Starck, 2005).

While the first of these measures, the production cost to the institution, is the most complete, it is the most complex to derive. One study attempted to compare the educational cost for various health professions. This study, sponsored by the Association of Academic Health Centers (Gonyea, 1998), used the 1994 methodology of Valberg and colleagues, which included 80 percent essential education and 20 percent complementary research and service (Valberg et al., 1994). The conclusion reached was that for every 1 physician (4 years), 14 advanced nurse practitioners or 12 physician assistants could be produced (Starck, 2005).

If one examines simply the cost to students of postsecondary training (the “sticker price”), the differences among professions are slightly less dramatic. The cost to students is defined as the tuition and fees students/families pay. This measure does not include costs associated with room and board, books, transportation, and other living expenses. Nor does it include those costs incurred by the educational programs that may be beyond what is covered by tuition revenues. Residency programs for physicians are not included in this estimate because students do not pay them.

Medical residencies are funded largely by Medicare, and in 2008, totaled approximately $9 billion per year ($100,000 on average for each of about 90,000 residents) for graduate medical education (MedPAC, 2009). Some of the Medicare expenditures are for indirect costs, such as the greater costs associated with operating a teaching hospital. Estimates of the average cost per resident for the federal government are difficult to establish because of the wide variation in payments by specialty and type of hospital. In addition, residency costs vary significantly by year, with the early years requiring more supervision than the later years.

Why More BSN-Prepared Nurses Are Needed

The qualifications and level of education required for entry into the nursing profession have been widely debated by nurses, nursing organizations, academics, and a host of other stakeholders for more than 40 years (NLN, 2007). The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature. However, several studies



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