Cost of Training
Transparency of data - Cost of training and examinations
The Royal College of Anaesthetists (RCoA), the Faculty of Pain Medicine (FPM) and the Faculty of Intensive Care Medicine (FICM) ensure that doctors in training, members and fellows are provided with an appropriate breakdown of costs of supporting doctors in training and in the provision of the examinations that form part of the relevant training programmes.
Costs of Training in Anaesthetics
The overall cost to an Anaesthetist in training who completes their training programme in seven years and passes all (Primary and Final) FRCA examinations at the first attempt, based on 2021 – 2022 RCoA membership and FRCA examination fees, is £3,620. This reflects seven years’ College membership for a trainee at a cost of £1,475 (calculated for the Final examinations being completed by the end of ST5) and an overall cost of all FRCA exam fees of £2,140.
Costs of Training in Intensive Care Medicine
The overall cost to an ICM trainee who completes their training programme in five years of specialist training and passes the FFICM examination at the first attempt, based on 2021-2022 FICM membership and FFICM examination fees, is £1,855. This reflects five years’ Faculty membership for a trainee at a cost of £770 (calculated for the examination being passed during ST6) and an overall cost of all FFICM Final exam fees of £1,085. ICM trainees will also, prior to joining the ICM programme, have undertaken a Primary examination which may have been that of one of the eligible ICM partner specialties rather than the FRCA, depending on that trainee’s background. Dual CCT trainees will also undertake a Final exam in their partner specialty and may hold membership with a partner College other than RCoA, depending on their dual specialty. The setting and costing of these exam and subscription fees are not set by RCoA/FICM and so fall outside the remit of this guidance.
There is a discounted rate for dual trainees for their 6.5 years’ Faculty membership.
There are no additional costs for Pain Medicine training as there are no membership fees and the FFPMRCA examination is optional. If the examination is taken, it will cost £1,270 if completed at the first attempt.
Costs of Provision of services
The breakdown of College expenditure is reported in the annual accounts that are published on the website and available from the Charity Commission.
All doctors in training appointed to a training programme in anaesthetics or intensive care medicine are required to register with the RCoA or FICM respectively as a member. There is no additional cost to doctors in training for the provision of the lifelong learning platform, curriculum development and management, or for the advice and guidance provided to support progress through the training programme. These functions are wholly included in the membership subscription.
The overall expenditure in 2021 - 2022, excluding the faculties, for running and supporting all exams was greater than the income generated from exam fees and the FRCA examinations made an overall contribution to the College of £4 for each candidate. The FFICM examinations are subsidised due to lower numbers undertaking the exam and therefore less direct economies of scale.
Variation in overall exam costs is dependent on the number of candidates, the complexity of exam delivery, equipment required, venue hire and additional staff costs. The Primary FRCA and FFICM exams incur further staff, resources and equipment costs in conducting OSCE exams which increases the overall running costs.
The FFPM exam requires subsidy due to the very small numbers of candidates at each sitting, around 10 - 14 candidates on average attend these exams, FFICM exams also need further subsidy due to smaller candidate numbers (approx. 80 per exam). The FRCA exams benefit from economies of scale, with approximately 320 candidates attending each exam.
Areas of expenditure
So why does expenditure outstrip income? The expenditure for all exams can be broken-down into three main areas:
- Operational and development costs
- Examiner and staff costs
- Overhead costs
Operational and development costs cover the day-to-day administration and running costs of each exam. This includes but is not limited to: The standard setting processes of the exam, marking and candidate feedback, exam review and management, question writing and exam content management, data analysis, exam equipment, hardware, software and IT costs. These fees also cover the development of candidate resources, guidance, candidate support and the training of examiners.
Development covers exam technology and future operational development costs such as; moving written exams to computer based testing, the development of online application and payment, electronic marking, question writing and pilot exams in respect to changes of exam formats. This is to ensure that all College and faculty examinations remain at the forefront of medical education and assessment and continue to remain fit-for-purpose.
Examiner and staff costs, the College and faculties do not pay their examiners but do cover day to day expenses associated with the role including, hotel accommodation and travel expenses. On average each FRCA examiner commits 12 days to examinations per annum. Faculty examiners commit approximately 6 days per annum. During the period of the COVID-19 pandemic the level of commitment required and provided was significantly more, for which the College is especially grateful. The examinations department is relatively small in comparison to other Colleges and consists of a Head of examinations, an examinations manager, a standard setting manager and a quality manager, two exam coordinators and four examinations administrators. Additional invigilators, actors and specialist contractors are employed as required to support the exams.
Overhead costs: To ensure the effective running of the examinations, the College and the faculties require the assistance and support of other departments and functions of the College. Costs are incurred in terms of room hire, financial services, human resources and the support, advice and direction from boards, committees, working parties, Council and ultimately the Board of Trustees.
Minimising costs. The RCoA, FPM and FICM are committed to minimising the cost of training and all examinations commensurate with maintaining the high quality of training for all doctors in training. As stated above, due to a small number of candidates applying for the FFICM and FFPMRCA examinations, the faculties encounter a greater cost per candidate this additional cost is reflected in the higher exam fees. However, the College and the faculties will always ensure value for money in the provision of training and examinations processes and therefore only increase exam fees where necessary.
Candidate fees. The information provided above show that overall the examinations have traditionally run at a deficit, but during the course of the pandemic the exams ran a net contribution to the College – this contribution was directed back into the examinations. Whilst during the pandemic period this may have not been the case, we anticipate this will continue to be the case as the examinations. However, the College and faculties are mindful that junior doctors face financial pressure during their training. Therefore, the College and faculties have not increased exam fees above the cost of inflation.
Tax deductibility. The College and faculties recognise that doctors in training who sit our examinations as part of a training programme can claim tax relief on their exam fees. Whilst in a training programme trainees can also claim tax relief on membership fees. Please visit HMRC for further information on how to claim.