Money for Nothing

An interesting article appeared in today’s New York Post. Turns out that the recently elected Governor Eliot Spitzer has caught on to the fact that several NY area hospitals were being paid for residents and fellows that were not actually training in the paid institution.

This is laughable to anyone who trains in a large city as hospitals are changing leadership and affiliations so frequently these days but medical education is rarely, if ever a real consideration in the transition.


Since hospitals are now run by administrators whose concern is to make money, they are much more concerned with the bottom line rather than medical education or the quality of academics at their hospital.

The Centers for Medicaid and Medicare Services (CMS) have been given the responsibility of paying hospitals for educating medical students and house staff based on the number of medical residents and doctors in training.
In New York, Spitzer and his staff discovered that for years, the state budget provided funding based on antiquated data. Through 2004, the state paid for resident-interns based on staff figures from 1981 and 1990. Does this surprise anybody?

"This [physician] education is critically important, but we're currently funding it in an excessive and irrational way that isn't directly correlated to the actual students being taught - thus costing the state exorbitant amounts of money in what amounts to general subsidies to teaching hospitals," Spitzer said.

"In fact, when we looked closer at this broken formula, we discovered that many of those dollars are going to pay for phantom residents and doctors who don't even exist. We will no longer pay for graduate medical residents who don't exist."
The problem is even more drastic then Spitzer knows. Hundreds of residency and fellowship vacancies exist in medical training each year. From esoteric heart failure fellowships to OB/GYN residency spots, ACGME-accredited spots go unfilled and there is no national database to feature them.

Instead, all of these medical training opportunities, which hospitals often get additional funding for, remain unfilled. Perhaps if training doctors were better informed of these existing training spots, they might be encouraged to apply for additional training or, training at all.

Often, medical training is the last consideration in the day-to-day running of a hospital which is ironic since so much of the care provided, particularly at large academic centers, is by those same residents, fellows and even medical students.