Lower Hospital Subsidies vs Lower Resident Hours: Now What?
Hi. I am Dr. Henry Black. I am Clinical Professor of Internal Medicine at the New York University School of Medicine, immediate past President of the American Society of Hypertension, and a member of the Center for the Prevention of Cardiovascular Disease. What I want to talk about today has relatively little to do with blood pressure. It has to do with medical education and training in the economic environment in which we live. What I am stating now is my opinion. There used to be a column in the New York Post called "Nobody Asked Me, But." This is a chance for me to give you my opinion about something.
We have conflicting forces going on right now. There is certainly a need to reduce spending, especially in the area of Medicare and Medicaid. There is also a need for more primary care physicians. There is an alleged physician shortage. At the same time, we have legislated restricted hours for our trainees in hospitals. This is something that those of us older folks didn't really worry about. We stayed with a patient who needed us. We didn't have to go home at a particular hour.
I think these competing forces are headed toward a collision course. There is now a proposal to reduce the amount of subsidy given by Medicare to teaching hospitals. The reasons for this are probably reasonable, that we have been overpaying these hospitals. The reason is that most teaching hospitals take care of many uninsured patients and patients who are underinsured. They need a little help for that. The people who have calculated this think that they have paid the hospitals too much. The reductions in resident hours were based on some concerns that a sleep-deprived resident would not be as careful, they would not be able to deal with emergencies that occur, and if we limited hours and required our trainees to go home and go to sleep and not work, this would reduce hospital errors, although I haven't seen that happen. The third concern is that as we age and we need more physicians, we must somehow educate and train them.
How will this work? If we reduce the subsidies to teaching hospitals -- if they really are subsidies -- then we are going to need fewer residents because those hospitals can't pay for them. We are going to need more residents if the hours are restricted. I don't see how this will work. If we need more primary care physicians, where are we going to train them? We can't train them in doctors' offices because right now, doctors -- primary care physicians in particular -- have an appropriate complaint that they don't have enough time to see their patients as it is. So, how will this work? We could train more physician's assistants and nurse practitioners but there is a shortage of them as well. They certainly are probably going to be willing to work a schedule, but with what a resident is paid compared with a nurse practitioner or a physician's assistant, the economics don't work either.
I am not sure how we are going to solve these problems with the current proposals. I wish somebody would tell me. Thank you very much.
Hi. I am Dr. Henry Black. I am Clinical Professor of Internal Medicine at the New York University School of Medicine, immediate past President of the American Society of Hypertension, and a member of the Center for the Prevention of Cardiovascular Disease. What I want to talk about today has relatively little to do with blood pressure. It has to do with medical education and training in the economic environment in which we live. What I am stating now is my opinion. There used to be a column in the New York Post called "Nobody Asked Me, But." This is a chance for me to give you my opinion about something.
We have conflicting forces going on right now. There is certainly a need to reduce spending, especially in the area of Medicare and Medicaid. There is also a need for more primary care physicians. There is an alleged physician shortage. At the same time, we have legislated restricted hours for our trainees in hospitals. This is something that those of us older folks didn't really worry about. We stayed with a patient who needed us. We didn't have to go home at a particular hour.
I think these competing forces are headed toward a collision course. There is now a proposal to reduce the amount of subsidy given by Medicare to teaching hospitals. The reasons for this are probably reasonable, that we have been overpaying these hospitals. The reason is that most teaching hospitals take care of many uninsured patients and patients who are underinsured. They need a little help for that. The people who have calculated this think that they have paid the hospitals too much. The reductions in resident hours were based on some concerns that a sleep-deprived resident would not be as careful, they would not be able to deal with emergencies that occur, and if we limited hours and required our trainees to go home and go to sleep and not work, this would reduce hospital errors, although I haven't seen that happen. The third concern is that as we age and we need more physicians, we must somehow educate and train them.
How will this work? If we reduce the subsidies to teaching hospitals -- if they really are subsidies -- then we are going to need fewer residents because those hospitals can't pay for them. We are going to need more residents if the hours are restricted. I don't see how this will work. If we need more primary care physicians, where are we going to train them? We can't train them in doctors' offices because right now, doctors -- primary care physicians in particular -- have an appropriate complaint that they don't have enough time to see their patients as it is. So, how will this work? We could train more physician's assistants and nurse practitioners but there is a shortage of them as well. They certainly are probably going to be willing to work a schedule, but with what a resident is paid compared with a nurse practitioner or a physician's assistant, the economics don't work either.
I am not sure how we are going to solve these problems with the current proposals. I wish somebody would tell me. Thank you very much.
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