Deciding on the appropriate makeup of the nation's future physician work force is a complex task, but one that's essential to revamping the healthcare enterprise.
Market forces often seem inadequate to respond quickly to the two problems facing the nation's medical education system: dwindling financial resources and a supply of specialists that's out of sync with the needs of a rapidly evolving healthcare system. The situation is aggravated because not all payers contribute their fair share to the training of doctors.
Some states are stepping forward to serve as a laboratory to help solve the knotty problem of reforming physician training. In Utah, state officials plan to introduce legislation during the upcoming legislative session to establish a state council that would control roughly $25 million in Medicare and Medicaid funding earmarked for medical education. If it can obtain a special waiver from HCFA, the council hopes to use its financial clout to help change the training sites from inpatient to outpatient settings.
Last week in Atlanta, the American Medical Association's House of Delegates approved a report urging that private-sector payers contribute to a fund from which reimbursement for providers' teaching expenses would be paid.
Although the House of Delegates backed off exclusive recommendation of a voucher-style system to finance the education of medical residents, it said one way of authorizing payments to teaching programs from the all-payer fund would be through the use of vouchers.
Clearly no single group has the answers that will solve the medical education conundrum. But the following provisions must be incorporated:
Managed-care organizations must help pay for medical education. One option would be a partnership among managed-care plans, the public healthcare system and existing education institutions to develop an academy for retooling and retraining health professionals.
If vouchers are used, they should be weighted to encourage more students to focus on primary care.
Teaching hospitals, which could lose a large chunk of their Medicare education reimbursements, expected to total
$8 billion in federal fiscal 1997, must be protected during any transition to a new system. In return, existing medical schools must pledge to create new doctor training programs that focus on primary care and community health and that view physicians as part of a team of health professionals.