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Charles Rainey, MD, JD

JAMA. 1999;281:1761.

Medicare reform and its affect on graduate medical education (GME) funding is likely to be one of the major legislative issues for physicians and medical students this year. The AMA held an open hearing on GME funding and the physician workforce in March 1999 to hear testimony from its constituents and from other groups. The AMA-RFS presented testimony, which included the following points.

Compensation for Teaching Physicians Should Support Education
The Health Care Financing Administration's rules for compensating physicians who teach and supervise residents need to be revised. The current rules, which were summarized in the June 25, 1997, Resident Forum column, require teaching physicians to be present during a key portion of a procedure and require detailed documentation in the medical record. Several hospitals have been audited and found in violation of these rules. These actions threaten teaching physicians who may respond by performing more procedures themselves, and thus deny residents valuable training experiences.

Full Funding for Second Residencies Should be Restored
The current rules, which were described in the November 20, 1996, Resident Forum column, limit full funding to the number of years for board certification in the first specialty that the resident chooses. These rules are shortsighted and overly restrictive. They reward residents who initially choose surgery or other 5-year specialties. The RFS routinely receives calls from physicians who wish to train in a specialty other than the one in which they initially trained and are told there is not enough funding for them to do so. Recently, a surgeon in a rural community called because she could no longer practice surgery due to an injury. When she tried to apply to primary care residency programs, she was dissuaded from applying because the hospital would not receive full funding for her training.

Young Physicians Need Debt Relief
Although this is not a Medicare issue, it is a funding issue and a factor that weighs heavily on a physician's choice of specialty. Resident physicians must have student loan relief to allow them to choose less lucrative primary care specialties. Congress has little or no sympathy for physician debt, but Congress needs to be educated about the effects of having a student loan debt of as much as $150,000. The RFS strongly encourages reinstating the tax deduction on student loan interest and increasing loan forgiveness and repayment programs for physicians working in underserved areas.

Other AMA-RFS policies mentioned in our testimony were:

• When discussing physician workforce planning, the government and other policymakers should not focus solely on residency programs but also on the medical school population.
  
• The AMA-RFS supports an all-payer system for funding GME and believes that funds should come from a source more stable and less political than the annual appropriations process.
  
• The AMA-RFS supports a voucher system that links funding to the individual resident and not the residency program, so as to provide residents with more program flexibility.
  
• The AMA-RFS agrees with the recommendation that residency program applicants should not be discriminated against based on the country in which they received their medical education.
  

Chair, AMA-RFS
Milwaukee, Wis

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