Report: U.S. to pay hospitals not to train doctors
August 24, 1997
Web posted at: 10:22 a.m. EDT (1422 GMT)
WASHINGTON (CNN) -- In an effort to reduce a glut of
physicians in the United States, the federal government will
pay training hospitals hundreds of millions of dollars not to
train doctors, The Washington Post reported Sunday.
The initiative, part of the new federal budget agreement,
also for the first time essentially forbids hospitals from
increasing the size of their residency programs, the paper
Medicare underwrites residency training programs heavily.
Taxpayers spend $7 billion a year on the training, with each
resident translating into an average subsidy of $100,000 a
Medicare spends up to $7 billion a year on physician training
programs. But with one physician for every 380 people in the
United States, critics say the government is paying for more
doctors than it needs.
Under the new plan, Medicare will instead pay hospitals to
shrink their residency programs. Hospitals that voluntarily
reduce residency training programs by 20 to 25 percent over
five years will get the full amount of the lost subsidies for
the first two years, with payments tapering off over the next
three years, the newspaper said.
After five years, the payments will cease, leaving the
program with fewer residents to underwrite. Administration
health officials and leading Republicans say the program will
save Medicare money in the long run, the Post reported.
The payments are the government's first effort to constrict
the pipeline of people entering the medical profession, and
one of the few times the federal government has used
subsidies as leverage to shrink a particular work force.
New York tried program first
The program mirrors an experimental program in New York
endorsed by the Clinton administration earlier this year.
Under the agreement between the Greater New York Hospital
Association and the federal Health Care Financing
Administration, which runs Medicare, New York is to receive
$400 million over several years to train fewer doctors,
especially in those in certain specialties.
Of the state's 75 teaching hospitals, the Post reported, 42
signed up for the program -- nearly four times as many as
But the agreement drew fire from teaching hospitals in other
areas of the country who were cutting their residency rolls
voluntarily and absorbing the cost of the lost subsidies
without federal assistance.
Some say agreement may have been unnecessary
Some government officials quoted by the Post said the glut of
doctors, particularly specialists, in the United States was a
growing problem, and argued that the budget agreement was a
valuable cost-cutting tool. "It remains a voluntary matter
of choice for these teaching hospitals. It isn't a mandate,"
said Ari Fleischer, a spokesman for committee chairman Rep.
Bill Archer, R-Texas.
Others wondered whether it was necessary. The number of
doctors training to become specialists in some fields has
declined dramatically despite the subsidy program, the Post
article said, due to well-publicized warnings that jobs for
specialists were only available in less populated areas.
The United States boasts over 700,000 physicians, more per
capita than any other country.