I find it completely unbelievable that residencies are not a profit center for most teaching hospitals. The residents do almost all the day to day work with a half dozen of them reporting to a single attending physician.

It’s not like you get a discount if you’re seen by a resident vs attending either. Sure the first year or maybe two a resident needs a lot of close supervision, but not nearly as much as people think happens.

I would bet dollars to donuts that the vast majority of patients seen by a resident have no clue. They simply call them doctor.

My bet is it’s all accounting tricks. You’d be utterly incompetent not to somehow make a profit on 60-80hrs/week of basically free doctor labor even if those are junior doctors. They generate massive amounts of billable services. Plus they are basically guaranteed to work for you for 4+ years, aside from the few that wash out.