Invisible assets: quantifying the hidden economic value of residency training in Italian public hospitals

Background Graduate medical education (GME) programmes are integral to healthcare systems, providing clinical manpower through medical residents whose compensation is externally funded in Italy. The financial impact of resident integration on public hospital budgets, particularly amid rising healthcare expenditures, remains poorly quantified. Methods We conducted a deterministic 12-month Budget Impact Analysis from the hospital perspective (EUR 2024), comparing an attending-only workforce with a resident-integrated configuration. Inputs included attending full-cost FTE (salary + employer on-costs), resident productivity by setting, supervision shares (translated into effective attending FTE), and departmental workload. Uncertainty was addressed through Monte Carlo probabilistic sensitivity analysis. Results This Budget Impact Analysis (hospital perspective; EUR 2024; 12-month horizon) found that integrating Ministry-funded residents reduced annual personnel expenditure by 40–50%. Replacing 40% of attending FTEs produced mean savings of €240,000 (95% CI: €205,000–€275,000). Sensitivity analyses confirmed the robustness of these savings across variations in staffing mix, supervision requirements, and resident productivity rates. Conclusion Externally funded residency programmes provide substantial, direct cost savings and support flexible workforce planning in Italian public hospitals. These findings support strategic investment in GME as a driver of economic sustainability and healthcare resource optimisation. Further research should address broader impacts on care quality and workforce stability.