I Need a Doctor: A Critique of Medicare Financing of Graduate Medical Education (original) (raw)
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The Physician Workforce and Financing of Graduate Medical Education
Annals of Internal Medicine, 1998
How well the supply of physicians in the United States matches national, state, and local health care needs has profound implications for public policy. Surpluses or shortages of physicians among specialties and the geographic distribution of physicians affect the access, quality, and cost of health care throughout the United States. The U.S. government and state governments traditionally have striven to ensure that the public receives medical services of the highest quality, that medical services are safe and effective, and that providers of medical services have the requisite education, training, and skills. It has also been public policy to encourage and sustain the institutions and resources that are essential for medical education and research and to help ensure that opportunities for medical careers are open to the best qualified applicants. However, the supply of physicians has continued to increase much faster than the U.S. population for more than 20 years, and market force...
Archives of Physical Medicine and Rehabilitation, 2001
Currently, the only explicit payers for graduate medical education (GME) in the United States are the federal and state governments. Of these, Medicare is by far the largest and most predictable payer. Through the prospective payment system, Medicare reimburses teaching institutions for both their direct and indirect costs associated with their GME programs. Because a well-educated workforce benefits patients covered by private, as well as public insurance, various proposals have been advanced to establish an all-payer pool to distribute the financial burden more equitably. Furthermore, Medicare policy affects physician supply. There is increasing recognition of potential physician oversupply, raising policy questions about the government's longstanding support of GME. In comparison with other specialties, physical medical and rehabilitation (PM&R) may receive more favorable treatment under future GME funding plans, for 2 reasons. First, under the formulas used by Medicare, PM&R training slots typically bring in more indirect revenue to teaching hospitals than is consumed in indirect expenses. This makes PM&R a relatively more attractive program to retain in the face of mandated reductions in training slots. Second, in many parts of the country, PM&R is not threatened by oversupply, making cuts less likely. Nevertheless, the high percentage of non-US medical graduates entering PM&R training may make the specialty vulnerable to future reductions in funded training slots.
On the Looming Physician Shortage and Strategic Expansion of Graduate Medical Education
Cureus, 2020
Among many other things, the novel coronavirus pandemic of 2020 highlighted the significance of physician shortages in the United States. Current projections anticipate a national shortage of up to 122,000 physicians by 2032, with shortfalls in both primary care physicians and specialists. Yet while this figure highlights the magnitude of the problem, it does not capture the distributional aspect of American physician shortages. Though some specialties and geographic areas have a surplus of physicians, others have a chronic undersupply. Appropriately addressing the looming physician shortage therefore requires not only creating more physicians, but also ensuring that those physicians practice in the areas of greatest societal need. This review explores the nature of physician shortages in the United States, identifies the present bottleneck in physician training at the level of graduate medical education, and considers potential legislative and policy solutions to allow strategic and deliberate expansion of graduate medical education and physician practice.
What goes around, comes around: a history of medical tuition
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2001
In this article the actual and relative costs of tuition at 3 Ontario medical schools are traced over the past 150 years. In addition, the factors that led to Ontario's nearly 4-decade experiment in private medical education (and to its eventual demise) are presented. In relative terms, tuition was stable for over a century, then declined (after 1960) as government support rose. Access to medical training for students from middle-income families may also have improved steadily until the late 1980s. Because there is no shortage of people wanting to become doctors, there seems to be no limit to the price that could be set for a medical education. The recent hikes in tuition have outstripped inflation and may be reducing accessibility to restrictive levels, similar to those that prevailed in the 19th century. The author invites readers to question current trends.
A Financial Forecast of the Medical Student Educational Burden, 2002-2042.
This study focuses on the effects of increased tuition and compensation trends on educational burdens of young physicians. I use financial analysis, and historical data to forecast tuition, fees, and interest payments for students entering the practice of medicine from 2002-2014, including costs financed through loans. I compare these costs with projected physician compensation over the same period. Finally, I compare these metrics to determine the overall economic burden on young physicians who will begin their education over the next 15 years. I created a forecasting model using SPSS using data from the U.S. Department of Education (DOE), the Bureau of Labor Statistics (BLS), and the American Association of Medical Colleges (AAMC). I adjusted all values to 2014 dollars. I found that debt for students attending medical school will increase such that over half of their net income will go to loans and taxes. Many excellent candidates may choose alternate careers exacerbating the current physician shortage unless changes are made to educational costs. From 2002-2014, undergraduate tuition and fees increased by 42.1%, or 2.97%/year. Medical school tuition and fees increased by 42.4% (2.99%/year). Simultaneously, BLS data reveal that physician income decreased by 4.80%, (-0.41%/year); primary care compensation increased 3.93% (0.32%/year). Meanwhile, student debt burdens increased by 27.9%. Since 2012, graduate students no longer qualify for subsidized graduate loans. These factors may discourage highly-qualified students from pursuing medicine. In my analyses I found that premedical-intent students now entering undergraduate education face significantly reduced net income. The model I used predicts that physicians who begin practicing in 2016 will pay a weighted amount of 38.6% of income to loans and taxes (adjusted for residency and control of school). 2016 undergraduate freshmen may pay 44.4% of income when they begin practice. In 2026, 50.1% of gross income would go to loans and taxes.
Academic Medicine, 2022
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians.When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.