We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Resident Physician Forum |

Teaching Hospitals in Trouble: Finding Solutions FREE

Paul Barach, MD, MPH
[+] Author Affiliations

Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

JAMA. 1999;282(17):1686. doi:10.1001/jama.282.17.1686.
Text Size: A A A
Published online

Last week's Resident Physician Forum column explained some of the financial challenges facing teaching hospitals and the threat that reduced funding poses to graduate medical education (GME). To address these challenges, legislators and medical educators have proposed several ways to strengthen GME funding.

Sen Daniel Patrick Moynihan (D, NY) has introduced a bill to revamp the financing of GME in the United States. His plan calls for freezing the GME subsidy at its current level and not permitting further annual reductions. Another suggestion has been to pay teaching hospitals directly for treating low-income patients and training nurses, rather than continuing to pay Medicare managed care plans for those services.

The National Bipartisan Commission on the future of Medicare and the Medicare Payment Advisory Commission have spent a great deal of time analyzing Medicare and its role in funding GME. Both groups recommended reducing the number of GME positions, providing transitional support for institutions that choose to downsize their GME programs, and providing stable support for teaching hospitals. They suggest that Medicare's direct medical education funding, which pays for the direct operating costs of a residency program, including resident and attending salaries and benefits, either be funded through a separate entitlement program or through a multiyear discretionary appropriations. They believe this would separate the needs of teaching hospitals from the prevalence of political machinations.

Some, including the American Medical Association, have suggested establishing a separate medical education trust fund that would be financed by a fee levied on private health insurance premiums, as well as contributions from Medicare and Medicaid. Maryland for example, has an all-payer statute, which requires contributions to GME funding by all insurers. This proposal has the advantage of broadening the burden of paying for medical education.

All stakeholders must come to regard the financial well-being of teaching institutions as vital to America's health care system. The ultimate standard for these institutions must be not only superior training and the dissemination of specialized knowledge, but also the ability to deliver the best medical care available anywhere. We must shore up this key part of the nation's biomedical infrastructure. All changes should aim to preserve the cost-containment measures included in the 1997 law. Simply plugging holes in the current funding patchwork will not ensure stability for the future.

If we want to continue at the cutting edge of research and provide the highest quality patient care, we must revamp the archaic system of financing medical education in the United States. For physicians to have any say in this critical debate, GME financing and infrastructure must become part of the undergraduate, graduate, and CME curriculum. If we do not make our voices heard, others will make these crucial decisions for us—decisions that will have ramifications for many generations to come.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles