Hos­pi­tal groups bris­tle over IOM re­port on doc-train­ing re­forms

Modern Healthcare - - NEWS - By Andis Robeznieks

Aca­demic medicine and hos­pi­tal groups are fum­ing about new rec­om­men­da­tions from the In­sti­tute of Medicine for over­haul­ing Medi­care-funded med­i­cal train­ing, rais­ing ques­tions about whether re­form is po­lit­i­cally pos­si­ble at this time.

The crit­ics sharply dis­agree with the IOM panel’s skep­ti­cism about whether a se­vere doc­tor short­age is im­mi­nent and whether an in­fu­sion of fed­eral money for more res­i­dency po­si­tions is de­sir­able.

The IOM re­port, over­seen by for­mer Medi­care chiefs Dr. Don­ald Ber­wick and Gail Wilen­sky, said that short­ages are cre­ated by poor ge­o­graphic dis­tri­bu­tion of physi­cians and lop­sided ra­tios of pri­mary-care and spe­cialty physi­cians and that the an­swers lie in new tech­nol­ogy and health­care-de­liv­ery in­no­va­tions.

“These stud­ies sug­gest that an ex­panded pri­mary-care role for physi­cian as­sis­tants and ad­vanced prac­tice reg­is­tered nurses, re­design of care de­liv­ery and other in­no­va­tions in health­care de­liv­ery, such as tele­health and elec­tronic com­mu­ni­ca­tion, may ul­ti­mately lessen the de­mand for physi­cians,” ac­cord­ing to the re­port.

To cor­rect the im­bal­ance of res­i­dency po­si­tions, the re­port rec­om­mends the cre­ation of a GME Pol­icy Coun­cil within HHS.

The re­port also rec­om­mends mov­ing more pro­grams out of aca­demic med­i­cal cen­ters and into com­mu­nity clinic set­tings. The Amer­i­can Hos­pi­tal As­so­ci­a­tion said this was al­ready be­ing done and dis­agreed with the di­rec­tion of the re­port.

Ken­neth Raske, pres­i­dent of the Greater New York Hos­pi­tal As­so­ci­a­tion, de­scribed the rec­om­men­da­tions as “rad­i­cal” and said they would weaken teach­ing hos­pi­tals’ abil­ity to train physi­cians.

Dr. Dar­rell Kirch, CEO of the As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges, said the rec­om­men­da­tions “would threaten the world’s best train­ing pro­grams for health pro­fes­sion­als and jeop­ar­dize pa­tients.”

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