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LSU Surgical Caucus AMA Interim Meeting New Orleans, LA November 14, 2011
Challenges Facing Academic Surgical Education in the Post-Health Reform Era
. . . . OR . . . .
* Bob Wachter – Assoc Chair, Dept Medicine, UCSF
Are Academic Medical Centers Toast in a Post-Healthcare
Reform World ?*
Peter W Carmel, MD, D Med Sci
Professor and Chairman
Department of Neurological Surgery
The New Jersey Medical School
Newark, New Jersey
President
The New Jersey Medical School
Honorary Alumnus!
Challenges Facing Surgical Education in the Post-Health Reform Era
• Manpower
• Financial Support (Who pays?)
• Length of Training/ Work-hours Restrictions
• Simulation
• Scope of Practice
Manpower
19
60
19
70
19
80
19
90
20
00
20
10
20
20
20
30
20
40
2,0
50
US Census-
100,000,000
200,000,000
300,000,000
400,000,000
500,000,000
US Census
y = xy = x1.1591.159
490,000,000
314,000,000
Almost 60 %
Your career
Workforce IssuesProjected Physician Shortage
Entering US Medical School Class 2011
• Largest entering class in US history – 18,665
• Up by 15.5% from 2003
• More than 42,740 applicants, (stable over 3 years), of which almost 32,000 were first-time applicants, also a record (up 2.5% from 2010)
• Eleven of 126 medical schools increased enrollment by over 10 % from 2006
• Survey indicates that schools plan enrollment of 19,300 by 2012 – an increase of over 14 % in decade
Increases in Entering Medical School Classes
• 1986-1987 16,779 0.74 %• 1996-1997 16,904
• 2003-2004 17,118 1.27 %
• 2006-2007 17,880 4.45 %
• 2009-2010 18,400 3.40 %
• 2011-2012 18,665 0.52 %
% Increase
Workforce IssuesProjected Physician Shortage
The limiting factor for increasing the number of physicians is the number of
residency positions
These positions are funded through Medicare, and are “capped” under the BBA of 1997
Medical schools have increased their enrolments 12 % over last four years
Congress must raise limits on residency positions
Unmatched Prior US US DOs TOTAL Positions US MD MDs UNMATCHED in Seniors Scramble
2008 883 663 531 2,077 1,3002009 1,072 677 605 2,354 1,0872010 1,078 747 601 2,426 1,0602011 971 764 617 2,352 1,035As recently as 2001, there were 2,383 GY1 positions available in
the Scramble. Now, for three years in a row, this number is less than half that. To make matters worse, most Scramble slots (606 of 1,035) are for preliminary positions in surgery (444), medicine (129), or transitional year (33), with no guarantee of future training.
Unmatched US MDs and DOs and “Scramble”
An increasing number of US medical graduates will be unable to find residency positions that
will lead to Board Eligibility/Certification
These graduates will have a difficult time getting hospital or clinic appointments
They will be qualified only for some of the lowest paying positions in medicine
Their average debt will be over $ 156,000
US Graduates are Being Denied Residency Training
THE BIGGEST PROBLEM
How to pay for Medical Education !
Tuition covers only 3.3% !
Graduating Medical Students
Nine out of ten students carry outstanding debt
The average medical student debt:
$ 156, 171
Average resident’s income:
$ 45,866
Medical School Debt
How Do Medical Students Pay for Their Education?
How to Pay for Graduate Medical Education ?
Medicare Support for Graduate Medical Education
Total Cost for GME $ 9.5 Billion
Direct Support $ 3.5 Billion
Indirect Support $ 6.0 Billion
Medicare Payment Advisory Commission (MedPac) Proposal (Oct 2011):
Cut Indirect Support by $ 3.0 Billion dollars!
1-800 833 6354
Teaching the Surgeons of the Future
The pressure on resident work-hours is likely to continue
We should be active in challenging some of the basic
assumptions of the “reductionists”
We should stress the importance of a chain of responsibility
We should emphasize the consequences of shortened training
We can not train residents to practice as we do – they will need to be much more efficient
It is likely that simulation will play an increasing role in our training
Teaching the Surgeons of the Future
The Administration will announce a new $ 1 Billion program to
expand the Healthcare workforce – this AM
Critical Time for Practice of Medicine !
The next two months will determine the fate of Medicine’s highest advocacy
goals:
Elimination of the Sustainable Growth Rate Formula
Medical Liability Reform
SGR Elimination: Delay Means Higher Costs
Message to Congress
A credible deficit reduction package should full repeal of the SGR
Recent bipartisan proposals have achieved over $4 trillion in savings while repealing the SGR
Recent “SGR patches” have increased the size of future cuts & the cost of full repeal
Medical liability reforms will lower health care costs by curbing meritless cases and reducing the practice of defensive
medicine.
We Must Act Now !
• AMA will invest significant resources to demand SGR fix – will involve TV, radio, print and internet advertising
• Must include grassroots effort by physicians and patients
We need your help!
Let Congress Hear from YOU!
Ama-assn.org/ama/pub/advocacy/get involved.page
Call Your Congressman – Toll-Free!
1 800 833 6354
