At their request, Boston teaching hospitals won't be getting any special breaks from the federal government to reduce the number of physicians they train. (See related editorial, p. 28)
By unanimous decision, the Conference of Boston Teaching Hospitals turned down HHS Secretary Donna Shalala's offer to include Boston facilities in a Medicare payment demonstration like one approved for New York hospitals, said Samuel O. Thier, M.D., chief executive officer of Partners HealthCare System in Boston.
Under the New York program, HCFA effectively agreed to pay hospitals to train fewer doctors. But Boston hospitals cried foul, arguing that the program should be extended to teaching hospitals nationwide, which led to the Shalala offer (March 17, p. 14).
Thier said HCFA's state-by-state approach to addressing the nation's oversupply of physicians is wrong. "We always started from the beginning saying this is the wrong way to do it. Make it an open national process," he said.
"I admire their decision," said Sen. Edward Kennedy (D-Mass.), who intervened on Boston hospitals' behalf. "They have once again shown the kind of leadership that makes them such an important national force for better healthcare."
HCFA would have required Boston hospitals to cut 20% of the total residents they currently train, Thier said. But at Partners, the parent of Boston's Brigham and Women's and Massachusetts General hospitals, officials began voluntarily shedding residency positions in 1994, he said.
Despite Boston's decision, some states continue to pursue a New York-like GME demonstration.
New Jersey teaching hospitals have proposed a similar GME payment program but so far have received no formal response from HCFA. The Hospital Association of Pennsylvania, meanwhile, is developing some specific GME proposals to present to its members.