Hospital groups bristle over IOM report on doc-training reforms

Academic medicine and hospital groups are fuming about new recommendations from the Institute of Medicine for overhauling Medicare-funded medical training, raising questions about whether reform is politically possible at this time.

The critics sharply disagree with the IOM panel's skepticism about whether a severe doctor shortage is imminent and whether an infusion of federal money for more residency positions is desirable.

The IOM report, overseen by former Medicare chiefs Dr. Donald Berwick and Gail Wilensky, said that shortages are created by poor geographic distribution of physicians and lopsided ratios of primary-care and specialty physicians and that the answers lie in new technology and healthcare-delivery innovations.

“These studies suggest that an expanded primary-care role for physician assistants and advanced practice registered nurses, redesign of care delivery and other innovations in healthcare delivery, such as telehealth and electronic communication, may ultimately lessen the demand for physicians,” according to the report.

To correct the imbalance of residency positions, the report recommends the creation of a GME Policy Council within HHS.

The report also recommends moving more programs out of academic medical centers and into community clinic settings. The American Hospital Association said this was already being done and disagreed with the direction of the report.

Kenneth Raske, president of the Greater New York Hospital Association, described the recommendations as “radical” and said they would weaken teaching hospitals' ability to train physicians.

Dr. Darrell Kirch, CEO of the Association of American Medical Colleges, said the recommendations “would threaten the world's best training programs for health professionals and jeopardize patients.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks