Copyright 1999 The Atlanta Constitution
The Atlanta
Journal and Constitution
June 13, 1999, Sunday, Home Edition
SECTION: Editorial; Pg. 4F
LENGTH: 756 words
HEADLINE:
EDITORIAL;
Physicians' training faces funding cuts
BYLINE: Staff
SOURCE: AJC
BODY:
In the past three decades, U.S. medical
advances have become the envy of the world --- magnetic resonance images of the
tissues inside our bodies, laser surgery, organ transplants, gene therapy
research that could make heart bypass operations a thing of the past someday.
Unfortunately, the system that brought those treatments to the patient is now in
jeopardy.
Until now, the latest scientific advances in medicine have
been translated into clinical care for ordinary Americans at the nation's
teaching hospitals, facilities such as Massachusetts General in Boston, Stanford
Medical Center in San Francisco, Grady Memorial Hospital in Atlanta and the
Medical College of Georgia Hospital in Augusta.
They are among the
nation's 1,250 teaching hospitals, where young doctors under the intense
one-on-one supervision of more experienced physicians perform the hundreds of
procedures that prepare them to care for all of us, sometimes in
life-threatening situations. They are the institutions that train 75 percent of
the nation's surgeons and provide care for 44 percent of the nation's indigent
patients. Medical education is expensive. It has always cost more than hospitals
or medical schools could afford. "You can't teach surgery to 100 residents at
once," says Dr. Jordan Cohen, president of the American Association of Teaching
Hospitals.
But the principle that medical education is a public good ---
one Congress confirmed in 1965 when Medicare was created --- was disregarded in
the 1997 Budget Act Amendment. That law slashed dramatically the portion of
Medicare funding historically earmarked for graduate medical
education. The cuts hurt already strapped teaching hospitals such as
Grady, which trains more than 400 resident physicians annually from Morehouse
and Emory medical schools and serves a disproportionate share of the indigent
population. Hospitals such as Emory University Hospital, which attracts a higher
percentage of patients covered by Medicare than public hospitals do, will also
be hurt by the cutback.
Nationally, teaching hospitals stand to lose an
average of $ 45 million in five years because of the medical education cuts. If
Congress doesn't act to limit the severity of the cutback, teaching hospitals
will lose $ 16 billion over a 10-year period, a financial blow that could force
many to shrink their vital training programs. Grady, for example, will lose $
55.1 million by 2002. Larger hospitals, such as Mass General, renowned for its
clinical research, could lose twice that much.
U.S. Sen. Daniel Patrick
Moynihan (D-N.Y.) has proposed a trio of bills to restore half of the lost
funds. Partisanship isn't much of a factor, though the partial restoration has a
$ 3 billion price tag. Sen. Jesse Helms (R-N.C) is a co-sponsor, for example, as
is Sen. Max Cleland (D-Ga.). In time, others in the Georgia delegation may offer
support as well.
If successful, the legislation might stop the
hospitals' hemorrhaging, but it won't heal the underlying problem. Managed-care
insurers don't usually contract with the more expensive teaching hospitals,
which means they contribute almost nothing to the training of doctors they
recruit. In fact, managed-care insurers pocket Medicare funds they receive that
were intended for teaching hospitals. The Moynihan legislation will correct that
windfall by carving out funds for training and indigent care and sending them
directly to the teaching hospitals.
That raises a second issue central
to the plight of teaching hospitals in the new competitive climate. Moynihan and
Rep. Bill Archer (R-Texas) have proposed creating a Medical Education Trust
Fund, which would require all participants in the system, including managed-care
insurers, to contribute to medical training, probably by adding a surcharge on
insurance premiums. Although a surcharge would be politically controversial, a
trust fund is a good idea, and there are many alternatives for funding it.
Training doctors in life-saving trauma procedures, the latest surgery
and technology, pays off in human lives saved, and it always will. The state's
second-largest teaching institution, the Medical College of Georgia Hospital,
treated Georgians from every county in the state but one last year. And Grady
provides the best trauma, burn and HIV care in the region.
The nation's
teaching hospitals are the underpinnings of American health care. Congress must
give immediate life support to these vital institutions and then look carefully
at options for a permanent cure.
GRAPHIC: Graphic
A
picture of a group of doctors slashed by funding cuts. / VERNON CARNE / Staff
Graphic
Medicare cuts
Georgia's teaching hospitals will have lost
millions of dollars in graduate medical education by 2002.*
Hospital................ Funds lost (in millions of dollars)
Grady
Memorial Hospital................ $ 55
Emory University
Hospital................47
Medical College of Georgia Hospital......27
Crawford Long Hospital........... ....... 42
Medical Center of Central
Georgia........25
LOAD-DATE: June 13, 1999
