The plan's proponents cite the $100,000 Medicare already pays to hospitals to train each resident in its support of graduate medical-education programs, often in specialties experts say are pursued by too many doctors who order up too many expensive procedures for too few patients. By steering doctors away from specialties into primary care and by encouraging other hospital personnel to perform routine medical procedures often passed off to medical trainees, advocates say the plan will save taxpayers money in the long run.
Many of the plan's critics seem to have been caught off guard. "A real coup for the New York teaching hospitals," is how Bruce Siegel, president of Tampa General Hospital, described the plan, which was originally proposed by the Greater New York Hospital Association. But he and organizations such as the Association of American Teaching Hospitals would have preferred to see a demonstration project open to other states as well as New York.
California Rep. Bill Thomas, chairman of the House Ways and Means subcommittee on Health, voiced concern not only about the plan itself but about the way in which it was approved. "I am concerned that what [the Health Care Financing Administration] has developed is not a 'true' demonstration, and the draft proposal could have benefited from increased planning and analysis." Thomas noted that California, in partnership with the University of California, already agreed to reduce 452 nonprimary-care residency positions between 1997 and 2001, without the benefit of bonus payments by the federal government.
[Ed.: A 1998 study by the American Association of Medical Colleges found that, contrary to what was previously thought, there was actually a surplus of primary-care physicians.]