Rainey C. AMA-RFS Testifies on GME Funding. JAMA. 1999;281(18):1761H. doi:10.1001/jama.281.18.1761
Medicare reform and its affect on graduate medical education (GME)
funding is likely to be one of the major legislative issues for
physicians and medical students this year. The AMA held an open hearing
on GME funding and the physician workforce in March 1999 to hear
testimony from its constituents and from other groups. The AMA-RFS
presented testimony, which included the following points.
The Health Care Financing Administration's rules for compensating
physicians who teach and supervise residents need to be revised. The
current rules, which were summarized in the June 25, 1997, Resident
Forum column, require teaching physicians to be present during a key
portion of a procedure and require detailed documentation in the
medical record. Several hospitals have been audited and found in
violation of these rules. These actions threaten teaching physicians
who may respond by performing more procedures themselves, and thus deny
residents valuable training experiences.
The current rules, which were described in the November 20,
1996, Resident Forum column, limit full funding to the number of years
for board certification in the first specialty that the resident
chooses. These rules are shortsighted and overly restrictive. They
reward residents who initially choose surgery or other 5-year
specialties. The RFS routinely receives calls from physicians who wish
to train in a specialty other than the one in which they initially
trained and are told there is not enough funding for them to do so.
Recently, a surgeon in a rural community called because she could no
longer practice surgery due to an injury. When she tried to apply to
primary care residency programs, she was dissuaded from applying
because the hospital would not receive full funding for her training.
Although this is not a Medicare issue, it is a funding issue and
a factor that weighs heavily on a physician's choice of specialty.
Resident physicians must have student loan relief to allow them to
choose less lucrative primary care specialties. Congress has little or
no sympathy for physician debt, but Congress needs to be educated about
the effects of having a student loan debt of as much as
$150,000. The RFS strongly encourages reinstating the tax
deduction on student loan interest and increasing loan forgiveness and
repayment programs for physicians working in underserved areas.
Other AMA-RFS policies mentioned in our testimony were:
When discussing physician workforce planning, the government and
other policymakers should not focus solely on residency programs but
also on the medical school population.
The AMA-RFS supports an all-payer system for funding GME and
believes that funds should come from a source more stable and less
political than the annual appropriations process.
The AMA-RFS supports a voucher system that links funding to the
individual resident and not the residency program, so as to provide
residents with more program flexibility.
The AMA-RFS agrees with the recommendation that residency
program applicants should not be discriminated against based on the
country in which they received their medical education.
We will continue to report on developments in GME funding and workforce
planning in future columns.