New Jersey teaching hospitals are developing a bold plan for voluntarily reducing the number of residents trained in the state while attempting to stabilize the shrinking pool of dollars that support those positions.
The proposal creates a "glide path" for gently landing teaching hospitals on their feet as they adjust staffing patterns and budgets to make up for lost residents.
Over a five-year period, New Jersey teaching hospitals w ould reduce the number of available residency positions to between 1,600 and 1,700. In 1995, they trained 2,890 residents.
With fewer residents in training, teaching hospitals would draw fewer graduate medical education dollars. Over five years, GME funding would slip to an estimated $320 million. New Jersey teaching hospitals currently receive roughly $600 million in GME support from Medicare and Medicaid combined.
The proposal is being developed by the New Jersey Joint Teaching Hospital Forum, a partnership of the New Jersey Hospital Association and University Health System of New Jersey, a consortium representing 15 teaching hospitals and the state's academic health center.
The forum seeks "an orderly and phased reduction in the number of slots, and therefore the funding" for those positions, said Stanley S. Bergen Jr., M.D., president of the University of Medicine and Dentistry of New Jersey.
The forum also would recommend that state officials empower the Advisory Graduate Medical Education Council of New Jersey to manage the flow of GME dollars and reduction of residency positions. Bergen is chairman of the 14-member council, which was created in 1978 to serve in an advisory capacity.
Because of the oversupply of physicians produced in the United States and federal budgetary pressures, New Jersey teaching hospitals fully expect Congress to begin slashing Medicare GME subsidies next year. But they also face an imminent reduction in state Medi-caid support for residency training.
Effective Oct. 1, the state has proposed cutting $32 million in Medicaid funding for GME. That figure includes $16 million in federal matching dollars.