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I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my pro
by kyouens 1y ago
I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.
- ambicapter 1y agoWho decides the funding?
- kyouens 1y agoFunding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.
- nradov 1y agoYou are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians. https://savegme.org/ https://savegme.org/
- lesuorac 1y agoSo after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician? Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
- nradov 1y agoAnyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies. If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
- lesuorac 1y ago> Most residents generate less revenue than they cost to train. Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier? I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.
- nradov 1y agoYou seem to be confusing amount of money with actual control. Electrical contractors can charge any price they want (subject to customer demand). Hospitals, especially teaching hospitals, have no such freedom. Medicare reimbursement rates are fixed by government fiat. This is not a free market. Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive. Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.
- deleted 1y ago[deleted]
- s1artibartfast 1y agoI think it is primarily a matter of insurance expectations and regulation of residents. It dictates what services they can bill for and the amount of redundant oversight required. It is a self imposed problem.
- nradov 1y agoThe problem is largely imposed by Congress in terms of strict rules about what hospitals are allowed to bill Medicare for. This is not something that teaching hospitals have imposed on themselves.
- resource_waste 1y agoWhy is the government paying for graduate education? I paid for my own graduate education.
- maxwell-neumann 1y agoThe costs would be utterly extortionate otherwise.
- resource_waste 1y agoNo. Don't let the cartel propagate this lie.