Medicare financing of graduate medical education: Intractable problems, elusive solutions

Eugene C. Rich, Mark Liebow, Malathi Srinivasan, David Parish, James O. Wolliscroft, Oliver Fein, Robert Blaser

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

The past decade has seen ongoing debate regarding federal support of graduate medical education, with numerous proposals for reform. Several critical problems with the current mechanism are evident on reviewing graduate medical education (GME) funding issues from the perspectives of key stakeholders. These problems include the following: substantial interinstitutional and interspecialty variations in per-resident payment amounts; teaching costs that have not been recalibrated since 1983; no consistent control by physician educators over direct medical education (DME) funds; and institutional DME payments unrelated to actual expenditures for resident education or to program outcomes. None of the current GME reform proposals adequately address all of these issues. Accordingly, we recommend several fundamental changes in Medicare GME support. We propose a re-analysis of the true direct costs of resident training (with appropriate adjustment for local market factors) to rectify the myriad problems with per-resident payments. We propose that Medicare DME funds go to the physician organization providing resident instruction, keeping DME payments separate from the operating revenues of teaching hospitals. To ensure financial accountability, we propose that institutions must maintain budgets and report expenditures for each GME program. To establish educational accountability, Residency Review Committees should establish objective, annually measurable standards for GME program performance; programs that consistently fail to meet these minimum standards should lose discretion over GME funds. These reforms will solve several long-standing, vexing problems in Medicare GME funding, but will also uncover the extent of undersupport of GME by most other health care payers. Ultimately, successful reform of GME financing will require "all-payer" support.

Original languageEnglish (US)
Pages (from-to)283-292
Number of pages10
JournalJournal of General Internal Medicine
Volume17
Issue number4
DOIs
StatePublished - 2002

Fingerprint

Graduate Medical Education
Medicare
Medical Education
Financial Management
Social Responsibility
Health Expenditures
Physicians
Costs and Cost Analysis
Budgets
Advisory Committees
Internship and Residency
Teaching Hospitals
Teaching
Organizations
Delivery of Health Care

Keywords

  • Graduate medical education
  • Internship and residency
  • Medicare
  • Teaching costs
  • Teaching hospitals

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Medicare financing of graduate medical education : Intractable problems, elusive solutions. / Rich, Eugene C.; Liebow, Mark; Srinivasan, Malathi; Parish, David; Wolliscroft, James O.; Fein, Oliver; Blaser, Robert.

In: Journal of General Internal Medicine, Vol. 17, No. 4, 2002, p. 283-292.

Research output: Contribution to journalArticle

Rich, Eugene C. ; Liebow, Mark ; Srinivasan, Malathi ; Parish, David ; Wolliscroft, James O. ; Fein, Oliver ; Blaser, Robert. / Medicare financing of graduate medical education : Intractable problems, elusive solutions. In: Journal of General Internal Medicine. 2002 ; Vol. 17, No. 4. pp. 283-292.
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