Monday, July 11, 2011

Family Physician Training: Save GME Funding for Primary Care

We have another primary care crisis.  Government funding for training primary care physicians is on the chopping block as Congress seeks to fund the Medicare budget for the next year and decade.

Currently, hospitals receive the money from Medicare and decide how to distribute it to pay for resident physician training.  Their budgets are tight, so they are more prone to use the money to fund more lucrative specialty training that brings in more revenue to the hospital.  The government must be encouraged to separate the primary care training money from the other training funds so the hospitals can't undermine training of primary physicians who are desperately needed to serve patient needs and to help "bend the cost curve" of excessive healthcare costs that are bankrupting America.

As an example of what's happening to primary care training, the two flagship hospitals in Dayton, Ohio both closed their Family Medicine training centers and shifted the training slots into cardiology fellowship training slots (all at Kettering Medical Center and some at Miami Valley Hospital which sent some Family Medicine slots to Good Samaritan Hospital, owned by the same entity), thus using the Medicare funds to support their new heart hospitals that opened in 2010.  One of them, Miami Valley Hospital,  even bulldozed the Family Medicine Residency Center that had been training family physicians for over 35 years.  What a message to the local community and the family physician community.

Tax payers via Medicare dollars pay for virtually all training of resident physicians and fellows who are trained in hospitals in adult specialties and subspecialties.  This is referred to as Graduate Medical Education (GME) funding, as opposed to Medical Education for medical students.  This may include $120,000 to $185,000 (or more) per resident per year depending on a formula involving actual expenses for physician training (including faculty salaries) in the "base year" of 1996.  With the pending addition of 30 million patients onto the public funded rolls, even more residency training is needed in primary care (and some other specialties).  Congress is debating whether some or all physician training should continue to be paid for with tax dollars.

The government will be strapped with those extra expenses through a Medicare program that is already facing cuts.  They have proposed cuts to GME funding as one element of financial survival.  Unfortunately, if there is less money for training, there are fewer doctors.  Sounds like Catch 22.  Cut budget to save the money to pay for the extra patients but have inadequate physicians to deliver care because of budget cuts.

The other part is the severe shortage of primary care physicians.  Only 8.4% of medical school seniors legitimately chose primary care in the specialty match this year.  We need at least 30%, but medical students emerge with an average debt of $175,000 and notice the lowest pay and highest workload and hassle factor are in the primary care specialties (Family Medicine, General Pediatrics, General Internal Medicine and  Combined Medicine/Pediatrics - which may also generate a tiny number of primary care physicians).  This impacts the pipeline generating primary care physicians for America.  Hence the 8.4%.

While actual primary care specialty careers are chosen by the 8.4%, the medical school deans ignore that number and include all of their graduates who start their residencies with general training as primary care physicians to satisfy the legislators, the public and donors.  Most report numbers over 50% as their graduates who choose primary care.  Sadly, even the media understand the sleight of hand about primary care numbers, but choose not to reveal it.  Just ask the medical school alumni office who is in what specialty when they ask for funds and they know.  Only the deans seem not to know.  This denial of reality is detrimental to the well-being of American citizens who might expect medical schools to better respond to the health needs of the public.

To adequately respond to the needs of the American people for primary care and prevent training hospitals and Universities from continuing to undermine primary care, we need Congress to SEPARATE PRIMARY CARE FUNDING from all other funding for physician training.  We need SEPARATE GME FUNDING for PRIMARY CARE!  The people need the primary care first.  PRIMARY CARE is the FIRST DOMINO of HEALTH CARE.

SAVE GME for Primary Care Training.  Let your representatives in the U.S. Congress and Senate know your opinion.
Use this link for the House, and this link for the Senate.

1 comment:

  1. Wow - I grew up in Kettering and was not aware that MVH closed their FM residency and bulldozed their family health center. (Just goes to show that we've got to keep sharing what we know with each other.) Thanks for a powerful and thoughtful post.