Sick people are at risk in hospitals due to inadequately supervised and monitored physican trainees. Seth's case is a tragic example of this. Due to fiscal constraints, it is now necessary to reduce the numbers of even this group of student doctors. But who will replce them? The article below appeared as an editorial in the February 28, 1997 issue of The New York Times. The Federal plan is to basically pay New York hospitals for training fewer physicians. The key sentence: "That will provide extra money with which to restructure patient care to accomodate the loss of residents." Who will replace them? Fully trained attending doctors who are not adequately supervising trainees now? Perhaps the replacements will be physician asssitants with even less training. Who will supervise them?
Fewer Doctors, Lower Medicare Costs
Hospital officials outside New York are reacting with jealousy, even rage, to the Clinton Administration's plan to pay New York hospitals hundreds of millions of dollars to train fewer physicians over the next six years. But the anger is misplaced. The plan is an innovative way to bring Medicare costs under control and, in the process, better match the nation's supply of physicians with patient needs. Rather than griping that they have been left out, teaching hospitals in Boston, Los Angeles and other training centers ought to root for New York's success in the hope that what is good for New York will soon become policy everywhere else. The goal of this demonstration project is to help reduce a national surfeit of urologists, anesthesiologists and other specialists. Hospitals have been slow to stop training young doctors, called residents, in such specialties because Medicare takes away up to $100,000 for every residency they cut out of their teaching programs. The medical community has blocked previous attempts to cut down on Federal teaching subsidies, in part because residents bear the brunt of treating uninsured, often
indigent patients in many urban neighborhoods. The prospects for success in the New York demonstration are enhanced by the fact that its provisions were proposed by the hospitals them- selves. Under the plan, teaching hospitals that voluntarily cut training slots by about 20 percent - perhaps 2,000 positions statewide - will be allowed to keep over the next six years about 60 percent of the Medicare subsidies for the positions that are eliminated. That will provide extra money with which to restructure patient care to accommodate the loss of residents. Washington also comes out ahead because it will reap partial savings, worth hundreds of millions of dollars, over the first six years and full savings by the seventh year. Some critics charge that Bruce Vladeck, a New Yorker who heads the agency that oversees Medicare, put together a sweetheart deal. But budget officials also approved the plan. New York is a proper test site because its hospitals train 15 percent of the nation's residents and treat many uninsured patients. If the project cannot succeed in New York, it cannot serve as a worthy national model.
In reponse to this editorial, we sent the following letter to The New York Times. They did not publish it.
Click for unpublished letter: Click for Home Page