Meyers LL. AMA Adopts Resolutions on Graduate Medical Education Funding. JAMA. 1999;282(14):1386K. doi:10.1001/jama.282.14.1386
Prepared by Ashish Bajaj, Department of Resident
and Fellow Services, American Medical Association.
At its Annual Meeting in June, the American Medical Association (AMA)
House of Delegates adopted the following actions regarding graduate medical
education (GME) funding. A complete summary of all House of Delegates actions
is available through the AMA web page at http://www.ama-assn.org/meetings/public/annual99/reports/reports.htm.
Preventing Negative Effects From the Balanced Budget
Act on Teaching Hospital Missions asked the AMA to work with other
organizations to maintain existing Medicare funding for GME until another
funding system is developed. The resolution also asked the AMA to continue
to advocate for adequate and stable funding for medical education and research
and equivalent funding for childrens' hospitals. The Balanced Budget Act of
1997, which reduced funding for teaching hospitals, seems to be contributing
to financial instability at teaching hospitals.
Noneducational Closing or Downsizing of Residency
Programs was referred to the AMA Board of Trustees for further discussion.
This resolution had asked the Accreditation Council for Graduate Medical Education
to encourage residency programs that undergo downsizing or noneducational
closings to seek funding for residency slots. The funding should be sufficient
for all residents in good standing at that program to complete their residency
training or should last until they have started in a commensurate paid residency
position. The House of Delegates felt that a comprehensive review of this
topic was needed.
Policy Options for Support of Graduate Medical Education summarized many AMA recommendations regarding GME funding and physician
workforce planning. The report discusses the number of medical school graduates
and funded GME positions. It also calls for a stable system of funding GME,
including contributions from all groups that pay for patient care. The complete
report is available at the above-named Web site.
Medicare Support for Duration of Residency Training asked the AMA to support a technical amendment to legislation regarding
Medicare direct medical education funding so that the legislation would support
full funding for all residents in an approved program up to the point at which
the resident is eligible to become board certified.
Medicare Payments to Teaching Physicians, the Primary
Care Exception concerns Medicare payments to attending physicians for
patient care provided by residents. Currently, the Health Care Financing Administration
allows attending physicians in primary care specialties to bill Medicare as
long as the attending physician is "immediately available." Attending physicians
in nonprimary care specialties must be physically present to bill for services
provided by their residents. The report recommends that the AMA (1) support
continuation of the "primary care exception" for teaching physicians, (2)
work with Health Care Financing Administration and Congress to modify the
primary care exception to extend to physicians' offices and other eligible
sites, (3) monitor and support legislation to enhance the availability of
teaching physicians through fair and consistent compensation, and (4) support
extension of the "primary care exception" to all specialties.