All healthcare payers should help finance graduate medical education at a variety of institutions providing physician training.
That's what the American Medical Association and other provider groups soon may recommend to the federal government.
A draft document being developed by the AMA suggests major changes in the structure of medical education. It says that rather than directing payments to teaching hospitals, Medicare's graduate medical education payments should be oriented around vouchers to students. They could redirect the dollars to the specific healthcare provider with whom they are training. Those vouchers could be adjusted to help the supply of physicians and specialists better match marketplace needs.
The AMA draft document is another in a series of reports recommending a drastic overhaul of the nation's medical education system.
Previous reports have called for a reduction in the number of medical schools, medical students and overseas students in U.S. residencies to alleviate a physician glut and raise the proportion of residents receiving primary-care training.
It also comes as many healthcare policy groups are anticipating that the next Congress and presidential administration once again will pursue a fundamental modernization of the Medicare system to reduce cost growth and bring the federal budget into balance. Reform of medical education financing is likely to be part of that restructuring effort.
The AMA draft document also recommends a reduction in the number of first-year residency positions to bring it closer to the number of U.S. medical school graduates. It recommends that within three years of implementation of GME reform, the number of first-year residencies exceed the number of U.S. medical school graduates by only 10%. In 1995, of 100,000 total medical residents in the United States, about 25,000 graduated from medical schools outside the country.
U.S. medical school graduates should be given first priority for vouchers, the draft document recommends, and international medical graduates should compete for any remaining residency positions after demand by U.S. graduates has been satisfied.
The Congressional Budget Office projects that Medicare will pay $8 billion in fiscal 1997, which began Oct. 1, to defray teaching hospitals' medical education costs.
The AMA, the Association of American Medical Colleges, the Association of Academic Health Centers, the American Association of Colleges of Osteopathic Medicine and the Institute of Medicine are trying to develop a consensus document to assist federal policymakers as they consider possible reform of the Medicare program.
At least one of the groups, the AAMC, said it hasn't signed off on the proposals contained in the AMA's draft document.
The AMA plans to hear testimony on possible changes to GME at the December meeting of its house of delegates. AMA officials could not be reached for comment.
The draft AMA document also recommends that hospitals dependent on residents receive "transitional" funding to aid them in developing "alternative means" of treating poor and disadvantaged patients.
In addition, the document recommends that the voucher-payment system offer bonuses to students who enter specialties that are in short supply or to practice in areas that are short of physicians.
One provider group lobbyist said he was skeptical that the AMA's draft recommendations can be implemented, particularly if Republicans retain control of Congress.
A Republican Congress may not be "interested in this as a public policy issue when the market's probably going to take care of it," said the lobbyist, who asked not to be identified.