Goal Is To Reduce Glut Of Doctors
In the past, market principles have not worked in the medical profession.
Even as the number of graduating doctors continued to saturate many specialties in medicine, physicians continued to find work in their chosen field wherever they wanted to live, while prospering financially. A town with 10 cardiologists would grow to 20 without significantly affecting another cardiologist’s annual income. What changed was the number of patients seen (more), the number of procedures performed (more) and often the cost (more again).
Those days are over. With managed care, we have entered the cost containment era in medical practice. Things are exactly the opposite now. In a managed care environment, the less doctors do to a patient the more money they make. Talk about a turnaround!
In addition, studies now reveal that a doctor glut now exists in this country. With 125 American medical schools turning out 17,000 young doctors each year for the past decade, and with 25,000 resident training slots awaiting these graduating students along with an additional 8,000 doctors from foreign medical schools, a clear solution to reducing the number of doctors is not easily found.
That has not stopped groups from trying.
The American Medical Association, along with representatives of the nation’s medical schools, recently stated that the United States was training too many doctors and that the number should be cut by 20 percent at a minimum.
Dr. William E. Jacott, an AMA trustee, commented he felt it was socially irresponsible to invest large sums in training doctors who are unlikely to find jobs practicing medicine after training. He is right. While many areas of America (especially rural and inner city) are under-served by doctors, the fact remains that large numbers of graduating doctors still flock to urban and suburban communities
Dr. Jordan J. Cohen, president of the Association of American Medical Schools, one of the five groups involved in the joint statement, stated that it won’t do to keep flooding the country with an excess of physicians, the vast majority of whom wind up in suburbia. The statement included a recommendation that the federal government start providing financial incentives for medical schools to train doctors who will then practice in rural and inner-city areas.
It also was recommended that the federal government begin limiting the money it spends on training doctors. Medicare subsidizes teaching hospitals over $7 billion annually to train resident physicians. Financially strapped teaching hospitals can ill afford cutting the number of residents they train since they would lose approximately $100,000 for each resident cut from their program.
What we do about this problem will depend largely on how a federal government experiment works in the state of New York. The experiment involves Medicare paying hospitals throughout New York not to train doctors.
Teaching hospitals that reduce their training positions by 20 percent will be given approximately 60 percent of the position’s eliminated funding, thereby allowing these hospitals to alter patient care to compensate for the loss of residents in training.
New York hospitals and the federal government support the plan, since it will save hundreds of millions of dollars spent in training physicians. If the project works, other states will be given an opportunity to participate. New York was chosen because, with 7 percent of the American population, it trains 15 percent of the nation’s residents, many of whom are foreign medical school graduates.
Of the 25,000 residents in training now, only 18,000 are actually needed. With American medical schools graduating approximately that number each year, it is clear this experiment will mostly affect foreign medical graduates. By significantly reducing foreign medical graduates from the pool of residents, medical schools will not need to cut back on enrollment. Commenting on this in The New York Times, Dr. Cohen stated American medical schools are already turning out an ample supply of doctors for the country’s needs, but the nation is importing 8,000 graduates from foreign schools. This just does not make sense.
If this plan cannot work in New York state, it cannot work anywhere. Stay tuned.
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