End CMS funding of GME

[Sushirolls]

I support the end of CMS funded GME. Programs are too entrenched in the status quo, and don't consider options of residency positions outside of their funding. This is stagnating the physician profession and allowing ARNP / PA to increase their numbers.

~100k to 120K is provided to GME offices to trickle down the expenses of a resident per year, including the benefits package. I may be wrong on this figure, but feel free to correct me with a more accurate number. The actual pay for a resident is about 50-70K per year, again correct me if I'm wrong.

An ARNP or PA will in general be paid by a hospital/clinic around ~100-140K per year, not including the benefits package. With a benefit package you are looking at ~130-150K per year.

Simply put, residents work more, harder, faster and take more call than any ARNP or PA every will.

Get rid of the GME CMS funding, and residencies will still exist. If anything, this artificial suppression of residency spots because of the concept of 'no funding' will disappear and a real, authentic, suit analysis of the numbers will show that a resident is still the best cheap labor and residency slots in the US will actually expand.

GME offices will shudder, and be shifted into existing HR departments. Depending on size there may need to be one or more designated HR employees to process the necessary paperwork for the ACGME bureaucracy machine. But consider the work generated compared to expenditure of salary and benefits related to a resident, the overhead is still a winning proposition. Factor in scale of size and increased residency positions, things get cheaper faster.

End the CMS funding of GME. Or please prove me wrong and educate me.

Pros: increased physicians thru residency, possibly less ARNP / PAs, less unmatched US grads, greater capacity to absorb IMG
Cons: less emphasis on teaching and more on service, less 'free money' to hospitals/clinics, less separate buffer from normal HR and likely treated more as any other employee ready to be fired

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[VA Hopeful Dr]

You do realize that a large percentage of residency spots aren't funded by CMS, right?

The funding hasn't increased since 1997 but we've added roughly 10,000 residency spots in that time.

 

[PikminOC]

You do realize that a large percentage of residency spots aren't funded by CMS, right?

The funding hasn't increased since 1997 but we've added roughly 10,000 residency spots in that time.

Who are they funded by?

 

[VA Hopeful Dr]

Who are they funded by?

The hospital that employs them

 

[Taddy Mason]

Who are they funded by?

And state governments.

 

[Sushirolls]

You do realize that a large percentage of residency spots aren't funded by CMS, right?

The funding hasn't increased since 1997 but we've added roughly 10,000 residency spots in that time.

I don't know this. Can I burden you with a helpful educational request, to post a link to such a source?

 

[VA Hopeful Dr]

To find total residency spots, go look at the NRMP website.

As for capping payments in 1997: The Role of GME Funding in Addressing the Physician Shortage

 

[splik]

many new residency positions in psychiatry are still funded by medicare because the number of residency positions in psychiatry prior to 1997 was much greater due to closing of residencies and shrinking of programs - the tide of which has been reversing in many years. but i do agree that CMS should not be funding residency positions. It makes no sense whatsoever. There are also many residency positions which are funded by other sources than CMS. Many programs have a hybrid of funding - that was true for my residency program (most slots were medicare but some were VA funded and some were funded by local state and county funds) and it is true for the program I am associated with now (most slots medicare, some have funding from the county or the state).

 

[NickNaylor]

There have been economic studies that suggest that residents are an economic boon for hospitals with authors making the argument that residents should both 1) be paid more and 2) the idea that they require funding to make them "cost-neutral" is a complete farse.

One way to incentivize hospitals taking on the cost responsibility of residents would be to allow residents to bill for services independently - perhaps at a reduced rate compared to attendings.