Advocate to Preserve Residency Funding

30 10 2011

bills,budgeting,businesses,cash,cost cutting,currencies,dollars,savingsSo, you have probably heard about the Supercommittee (gang of 12) and the need to brace for massive cuts to control federal spending.  But, do you know that the chief target is RESIDENCY TRAINING!   That is right.   Funding for residency largely comes from Medicare, and the general concern is that they are paying too much and not getting their money’s worth.  Of course, this comes at a time when there is a shortage of residency spots given the expansion of US medical schools, and a dire need for physicians, especially in primary care, to meet the needs of healthcare reform.

So, in this perfect storm, 40 medical groups (yes, there was that much consensus) sent a letter to the Supercommittee pleading with them not to cut GME funding.   Now the situation is dire enough that the AAMC advocacy leaders are in high gear encouraging those in graduate medical education to encourage their residents to write to their Congressman.  (And yes, if you live in a Supercommittee state, its even more important for you to do this).

So if you are a resident or future resident or can sympathize with the need to have future physicians, now is the time to take action.   For my fellow medical educators out there, you don’t need to be left out.  The American College of Physicians has a very broad (don’t need to be an internist)  easy-to-use advocacy website to shoot of a quick note to your Representative and Senator about the need to preserve GME funding.

Medical educators have actually started a dialogue about the role of advocacy in medical education.  Specifically, the Editor of Academic Medicine has challenged us to come up with how advocacy should properly be integrated into medical training.  I can think of no other way than advocating for preserving funding for the system by which we train our nation’s future physicians.

Vineet Arora MD

(AAMC email encouraging residents to take action)

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Dear Resident:

I encourage you to take a few minutes to  visit the AAMC Legislative Action Center (http://capwiz.com/aamc/home/), select “Residents”,  and send an electronic letter opposing cuts in Medicare funds that support residency programs.   With the zip code you enter, the letter will be sent automatically to your Senators and Representatives urging them to oppose GME cuts as part of deficit reduction.  PLEASE USE YOUR PERSONAL EMAIL ADDRESS (eg, gmail.com), AND NOT YOUR INSTITUTIONAL EMAIL ADDRESS.

Congress is discussing a deficit reduction proposal that would cut funding by as much as 60%, or $60 billion, for Graduate Medical Education (GME) and jeopardize residency training programs across the country. Given the current and growing shortage of physicians, GME cuts will reduce access to health care and threaten the well-being of all Americans.

It is most important that residents enrolled in programs in Arizona, California, Washington State, Massachusetts, Ohio, Pennsylvania, Montana, Michigan, Maryland, Texas, or South Carolina, voice your concerns.    You are represented by members of the “Super Committee” that will finalize the deficit reduction plan.

Thank you for your help.

Atul Grover, M.D.
Chief Advocacy Officer
AAMC





Differences Between Real & Fake Patients

9 10 2011

Each morning this week, I am rounding on a busy inpatient general medicine service in an academic hospital seeing real patients.  Each night this week, I am also studying for the internal medicine recertification exam where I am doing countless MKSAP questions which present the diagnostic and management conundrums of “fake patients.”   While there are a variety of things I could say about the process, one thing is clear- the real patients don’t ever come as neatly wrapped and easy to figure out as the pithy and succinct questions based on fake patients in the prep questions!   Perhaps the most distinct differences are that real patients suffer from real problems that plague real people…and that is of course why one of the most important lessons for our medical students is that being a good doctor is more than just how well you do on a standardized exam.  It is knowing how to mobilize a team and resources to tend to all of these problems in the same patient.   Here are just a few ways in which the real patients we see differ from testable “patients.”

  • Social problems trump medical problems – Many of the patients we see suffer from poor health literacy, lack of insurance, access to safe housing, affordable healthy food, and access to healthcare outside of the hospital that prevents optimal care and treatment of their medical conditions.  Understanding how to bring up and address these problems is equally important to design a customized care plan for a patient that will ensure their most optimal recovery and health outside of the hospital.
  • Caregiver support- Many older patients who are chronically ill are cared for by family members who suffer a lot of stress.  This stress manifests in different ways and sometimes you see that sigh of relief when they come to the hospital since they are in need of as much care and support as their family member.  Arranging home services and providing and ensuring caregiver support is a key part of hospital care these days.
  • Insurance compatibility – Most patients require services that go beyond hospital discharge, such as home IV antibiotics or short-term rehabilitation stays after hospitalization to recover.  In addition, patients often require close follow up after hospitalization. Unfortunately, arranging such things for patients who are uninsured or underinsured is increasingly difficult.  Perhaps this is one thing that we can hope to change with the implementation of the Affordable Care Act- lets at least hope so.  But for now, it’s sometimes a guessing game how to piece together the most logical plan that will also be optimally covered.
  • Medical necessity – These days, patients can’t stay in the hospital to “recover” unless it meets strict criteria for inpatient admission.  This process is audited by private contractors so hospitals are required to follow strict guidelines or face harsh penalties from Medicare.  The challenge is that for a variety of social issues documented above, patients may not be ready to go home (caregiver not ready, patient lacks understanding regarding illness, etc.) but they have to go home or be faced with footing the bill for their stay.   Given that rock and a hard place, it’s a difficult position for any doctor to be in.

Because medicine does change and evolve very quickly, we refresh our medical knowledge every 10 years by testing our clinical acumen through ‘caring’ for fake patients on a written exam.  But, a written exam can only go so far…Given the sea changes occurring on a daily basis in our healthcare delivery system, it is equally important to stay up-to-date on systems-level changes that influence how we can actually provide care for real patients.  After all, both are necessary for good doctoring.

Vineet Arora, MD








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