What Does Medicare Have to Do with Graduate Medical Education?
https://www.aamc.org/initiatives/gmefunding/factsheets/253372/medicare-gme.html
It most certainly cannot be done this way ..
GME funding showdown looms in Washington
Many in organized medicine want more residency positions, but government officials have recommended reducing federal GME spending.
For years, medical educators and others in academic medicine have warned of the need to expand federal funding for graduate medical education to stave off impending physician shortages.
Nationwide, work force shortages are expected to reach 62,900 physicians by 2015 and 91,500 by 2020, according to the Assn. of American Medical Colleges. More doctors will be needed due to an aging population, rising chronic disease rates
and an influx of an estimated 30 million newly insured individuals over the next decade under the Affordable Care Act.
Despite those projections, there have been multiple proposals to slash GME funding as pressure mounts for Congress to reduce federal spending and prevent automatic, governmentwide cuts from taking effect starting in 2013. GME reductions as high as 50% have been recommended by the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform, as well as President Obama’s budget proposal.
However, some physicians and others are backing a proposal to expand GME funding. Introduced Aug. 2 in the House, with a companion bill in the Senate, HR 6352 calls for Medicare to add 15,000 more residency slots over five years.
Medicare contributes the bulk of GME funding, about $9.5 billion a year.
“The U.S. is already facing the reality of having a significant shortfall in trained doctors and medical professionals, and this shortage will only continue to grow if we don’t begin to address the problem now,” said
Rep. Aaron Schock (R, Ill.), the bill’s sponsor.
Medicare funding for GME has been capped since the Balanced Budget Act of 1997, raising concerns that there won’t be enough residency positions to train an expanding pool of U.S. medical school graduates. Cutting those funds would be devastating, said Stephen Shannon, DO, MPH, president and CEO of the American Assn. of Colleges of Osteopathic Medicine.
“The shortage of physicians in our health care system, particularly in primary care, is nothing short of a national crisis,” he said.
The American Medical Association has supported lifting the 1997 funding cap. AMA policy says the Association will advocate to increase GME positions to address physician work force needs.
During the last several years, medical schools have responded to physician shortage projections by expanding class sizes and opening new allopathic and osteopathic schools for the first time in decades. But that growth hasn’t been mirrored in GME.
“There has been some growth, but it has been pretty marginal,” Dr. Shannon said. “There is increasing recognition that there is a squeeze coming. None of us wants to be graduating students who can’t go on to do their residency training to become physicians.”
---
Without more federal money, many residency programs cannot grow to meet increasing demands, said Lisa Bellini, MD, vice chair for education in the Dept. of Medicine at the University of Pennsylvania Perelman School of Medicine.
“There are only so many sources of revenue for hospitals,” she said. “It just gets more and more difficult to expand or even maintain what you’ve got.”
---
HR 6352, also known as the Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, would do more than expand Medicare funding for an additional 15,000 GME slots. It also would require academic medical centers to meet new performance standards or risk payment reductions.
The American Medical Student Assn. would like to see more focus on ensuring that any expansion of funding is tied to meeting society’s health care needs, particularly through training more primary care physicians, said AMSA President Elizabeth Wiley, MD, MPH.
---
While debate continues about how best to fund and structure GME, many agree that proposals to cut GME funding suddenly would be devastating to the system.
After surveying GME programs, the Accreditation Council for Graduate Medical Education estimated in a 2011 report that a 50% reduction in Medicare GME funding would result in the closing of 2,551 residency and fellowship programs nationwide and the loss of 33,023 GME positions.
Such cuts would result in some U.S. medical school graduates losing their chance to complete training, said Dr. Wiley, of the AMSA. Cuts also would hit teaching hospitals, which rely on physicians-in-training to help care for patients at less cost than attending physicians.
“It’s a recipe for disaster,” she said.
http://www.ama-assn.org/amednews/2012/08/27/prl20827.htm
So at the same time the healthcare system is suffering from a lack of doctors during an explosion of new patients ..
the Obama Administration is planning to cut funding for GME training.
