Proposed Medicare funding cuts for graduate medical education (GME) would incent hospitals to focus on specialty residencies and possibly worsen the primary care physician (PCP) shortage, according to a Bloomberg Government study.
President Obama's fiscal year 2013 budget proposed a series of health care cuts—including a $9.7 billion reduction in federal GME funds—as part of his plan to reduce the federal deficit by $4 trillion over the next decade.
The Bloomberg Government study projects that the GME cuts will force many hospitals to adjust their residency mix to prioritize specialties—which generally are more profitable—and less on primary care. That shift would further encourage prospective physicians to pursue specialties, which are generally more lucrative than primary care.
According to the Association of American Medical Colleges (AAMC), the proposal would worsen the nation's PCP shortfall. "You can tell people primary care is great all you want, but unless you show you value it through the payment system, people are always going to go the for the economic incentives," said Atul Grover, AAMC's chief public policy officer.
Bloomberg Government and industry experts say that shift would undermine a top priority of the Affordable Care Act (ACA), which seeks to extend health insurance coverage to an additional 32 million uninsured residents and expand primary care.
Hospital leaders caution that the ACA's existing payment cuts leave them ill-prepared to absorb new reduction in GME. "If a hospital agrees to cuts and then you say, now we want to cut further, they're making it impossible to have the resources to train the doctors," says New York Presbyterian Hospital EVP Herbert Pardes (Frier, Bloomberg, 3/1).