Healthcare reform should include a drastically simplified financing plan for graduate medical education, a congressional advisory committee told Congress and the Clinton administration last week.
The Council on Graduate Medical Education said at least 50% of new physicians should go into general practice as family physicians, internists or pediatricians. The panel also called for a policing mechanism at the local level to ensure GME is producing 50% primary-care physicians by the year 2000.
"There is considerable debate to limit the growth in the physician supply," said Lawrence Clare, M.D., deputy executive director of Bethesda, Md.-based COGME.
By the year 2000, COGME estimates there will be a shortage of 35,000 general physicians and a surplus of 115,000 specialists. U.S. medical schools graduate about 17,000 students each year.
The COGME plan would allocate federal medical education money to consortia, which would include medical schools, teaching hospitals, community hospitals and community health plans. "To get the desired numbers of primary-care physicians, the number of needed physicians would adhere to the needs of the providers in the consortia," Dr. Clare said.
The number of consortia could be as high as 141, which equals the number of the nation's medical schools, but it's likely to be lower because there are many cases in which two medical schools exist in the same geographic area.
COGME's formula would be simpler than current financing, which allocates money to some 1,500 institutions that sponsor about 7,000 residency programs, COGME said. With current medical education formulas, any institution can receive money as long as it has at least one resident and an accredited residency program. No policing mechanism exists.
Every residency program would be affiliated with the consortia, and they collectively would decide how to allocate the number of specialist positions.
COGME's final report was presented to HHS, the House Energy and Commerce Committee and the Senate Labor and Human Resources Committee. The council had four earlier drafts of its recommendations.
The nation has 653,000 physicians, including 535,000 actively involved in patient care, COGME said.