Proposed elimination of pediatric GME

[SurfingDoctor]

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Well, if you ever once thought that the GOP had even the littlest interest in child welfare and healthcare (beyond embryos)... let me put your mind at ease.

CHA Statement on Trump Administration Proposed Budget That Eliminates CHGME

Children’s hospitals urge greater investment in pediatric health care training.

www.childrenshospitals.org

“We are alarmed by the proposed elimination of the Children's Hospitals Graduate Medical Education (CHGME) program. At a time when major cuts to Medicaid and other programs for children are being debated in Congress, we can’t have the elimination of CHGME, too. Children’s health care lies in the balance,” said Matthew Cook, CHA’s president and CEO.

“Eliminating federal funding for the CHGME program threatens children’s health and puts the ability of our children’s hospitals to train the next generation of pediatricians and pediatric subspecialists at risk.

“More than half of both pediatricians and pediatric specialists are trained at CHGME hospitals. In the academic year 2022-2023, 15,860 residents and fellows were trained at children’s hospitals with support from CHGME funds. A strong CHGME program for children’s hospitals is essential to addressing our pediatric health care workforce shortages.

 

[Oso]

Seriously though, what is their goal??

 

[pawprint]

This does ask a good question at least:

Why does the federal government fund GME in the first place? I’ve never understood why our residency programs are funded by Medicare.

I know I don’t understand the profound intricacies of it, but from a surface level understanding of the issue, wouldn’t it make more sense for teaching hospitals to foot the bill to pay their employees themselves? Residents should be paid substantially more than they make now, and cutting the ties from Medicare would put the responsibility on teaching hospitals to offer competitive salaries for residents.

Right now the excuse I hear is “resident salaries are low because they are funded by Medicare”….so let’s cut the federal dependency and force hospitals to pay their employees what they are worth and compete against other hospitals for salaries.

 

[DO2015CA]

This does ask a good question at least:

Why does the federal government fund GME in the first place? I’ve never understood why our residency programs are funded by Medicare.

I know I don’t understand the profound intricacies of it, but from a surface level understanding of the issue, wouldn’t it make more sense for teaching hospitals to foot the bill to pay their employees themselves? Residents should be paid substantially more than they make now, and cutting the ties from Medicare would put the responsibility on teaching hospitals to offer competitive salaries for residents.

Right now the excuse I hear is “resident salaries are low because they are funded by Medicare”….so let’s cut the federal dependency and force hospitals to pay their employees what they are worth and compete against other hospitals for salaries.

most hospitals are in the red currently. They probably would opt for the decision to switch to midlevels under an attending where they don’t have to worry about education metrics. Not because it’s the better option or safer but because it’ll be cheaper for them, especially if resident salaries increase.

 

[SurfingDoctor]

Finally… we have a system where the rich kids get colonics and raw milk and the poor kids can get fu-ked. It’s about time.

Unless they are embryos…

 

[SurfingDoctor]

This does ask a good question at least:

Why does the federal government fund GME in the first place? I’ve never understood why our residency programs are funded by Medicare.

I know I don’t understand the profound intricacies of it, but from a surface level understanding of the issue, wouldn’t it make more sense for teaching hospitals to foot the bill to pay their employees themselves? Residents should be paid substantially more than they make now, and cutting the ties from Medicare would put the responsibility on teaching hospitals to offer competitive salaries for residents.

Right now the excuse I hear is “resident salaries are low because they are funded by Medicare”….so let’s cut the federal dependency and force hospitals to pay their employees what they are worth and compete against other hospitals for salaries.

Frankly, if they are doing this, they might as well eliminate training and just make it APPs. That would also help with some of the administrative bloat that goes with training programs.

 

[pawprint]

Frankly, if they are doing this, they might as well eliminate training and just make it APPs. That would also help with some of the administrative bloat that goes with training programs.

I don’t think this is true. Sure, APPs might be cheaper (although APPs make twice the salary of a resident, so not sure about that), but the prestige you bring in from being a teaching hospital brings in patients, which brings in money. The most complicated patients want to go to the best hospitals, and the best hospitals are involved in academia and train residents.

I don’t think the future of residency training needs to be dependent on federal funding in order to protect hospitals from replacing residencies with mid level hiring.

 

[SurfingDoctor]

I don’t think this is true. Sure, APPs might be cheaper (although APPs make twice the salary of a resident, so not sure about that), but the prestige you bring in from being a teaching hospital brings in patients, which brings in money. The most complicated patients want to go to the best hospitals, and the best hospitals are involved in academia and train residents.

I don’t think the future of residency training needs to be dependent on federal funding in order to protect hospitals from replacing residencies with mid level hiring.

That’s absolutely wrong. Prestige may generate some philanthropy, but little more. The general public could care less.

What’s more, the most complicated patients generate the least amount of money because they are all 1) complex and take a lot of resources and 2) are generally on public insurance with poor reimbursement.

 

[DO2015CA]

That’s absolutely wrong. Prestige may generate some philanthropy, but little more. The general public could care less.

What’s more, the most complicated patients generate the least amount of money because they are all 1) complex and take a lot of resources and 2) are generally on public insurance with poor reimbursement.

Lots of free stays too because insurance doesn’t think some of these complicated patient’s stays are necessary. Whole heartedly disagree about the prestige thing being linked to teaching explicitly. Patients don’t care about the residents. If the team members were replaced with order servants then they couldn’t care less or be any the wiser.

 

[pawprint]

I seriously doubt a place like CHOP would go “oh we aren’t receiving federal funding for our residents any more? Guess we will just abandon our mission to train the next generation of pediatricians and switch to hiring mid levels.”

They would pay for their residents regardless of federal funding, and then wouldn’t be able to fall back on the excuse of federal funding as why their resident salaries are so low.

Connecting residency salaries and the federal government doesn’t make sense. If we were creating a new system from the ground up today, nobody would suggest that because it just doesn’t make sense.

 

[SurfingDoctor]

I seriously doubt a place like CHOP would go “oh we aren’t receiving federal funding for our residents any more? Guess we will just abandon our mission to train the next generation of pediatricians and switch to hiring mid levels.”

They would pay for their residents regardless of federal funding, and then wouldn’t be able to fall back on the excuse of federal funding as why their resident salaries are so low.

Connecting residency salaries and the federal government doesn’t make sense. If we were creating a new system from the ground up today, nobody would suggest that because it just doesn’t make sense.

Okay. How?

 

[DO2015CA]

I seriously doubt a place like CHOP would go “oh we aren’t receiving federal funding for our residents any more? Guess we will just abandon our mission to train the next generation of pediatricians and switch to hiring mid levels.”

They would pay for their residents regardless of federal funding, and then wouldn’t be able to fall back on the excuse of federal funding as why their resident salaries are so low.

Connecting residency salaries and the federal government doesn’t make sense. If we were creating a new system from the ground up today, nobody would suggest that because it just doesn’t make sense.

Applying the top 5 institutions game accounting for a total of 150-180 residents isn’t going to apply to most pediatric residencies. It’s also not going to supply enough graduates per year to the workforce.

I agree from inception way before the midlevel rise but there is competition (for a lesser product). The systems hurting will go with the cheaper product and then lean on the supervising physicians more.