Cutting Physician Education Funding: How the AMA Resolution Process Corrected the Administration's Misaligned Priorities

MAY 18, 2007

Dear Colleague,

Do you think that healthcare in the United States is perfect? That training is optimal and could not be improved? That all Americans get the care they deserve? We likely agree that the answer to these questions is no. We cherish the healthcare we can provide, but to say that the system needs comprehensive reform is an understatement. So, if there is something you want to change, here is an easy way to get started:
? Name the problem
? Come up with the solution (or decide that it needs a study)
? Write the resolution and submit it to the American Medical Association (AMA)
Resident and Fellow Section
? If it passes, the AMA will use its dollars and powers to make your idea a reality.

Does this sound too good to be true? It is not?this is just what the AMA does.

Go to and click on the ?Resident and Fellow Section? link for more information about how to make changes and how to join us in Las Vegas for our Interim Meeting this November.

Do you think that you cannot make a difference? Then read the following story about a resolution from our last meeting:

Medicare threatened to cut all our (ie, residents?) conferences?and one resident?s resolution helped make this threat go away.

You probably already know that, almost universally, the funding for our residencies comes from Medicare (with a few exceptions, such as pediatrics and preventive medicine residency programs). Medicare pays our hospitals with a relatively complex formula, which is predicated on many things but most prominently on the number of residents in your institution. In April, the Centers for Medicare & Medicaid Services (CMS) issued its proposed rule for inpatient hospital payments in the 2007 fiscal year, which included a number of provisions relating to payment for graduate medical education.

To be paid, your hospital has to report how much time you and your colleagues spend in your jobs as residents. The proposed rule stated that resident time spent in didactic activities, such as educational conferences, journal clubs, and seminars, would be specifically excluded. What does that mean? If you are a surgeon and want a lecture on surgical techniques or postop care, Medicare will take it out of your hospital?s pay. Hey internist?how about a lecture on antibiotics, anticoagulation, or hepatitis? Sorry, your hospital will lose money.

The potential ramifications of this decision on residents? and fellows? training could have been staggering, such as:

? Funding for many hospitals could have been overwhelmingly undermined, possibly resulting in forced mergers, or worse yet, hospital and residency program closings

? Residents would likely have received indirect pay cuts as a result of departments? inability to afford book allowances, travel reimbursement, parking, food vouchers, white coats, and so on

? Quality of education during training may have been significantly reduced because of hospitals having to make a forced decision between profitability and resident education

? Healthcare for the indigent population would have been compromised, because many hospitals that would have been affected serve this particular community, ultimately increasing limitations of the uninsured?s access to quality healthcare.

Why did these changes not occur? Thanks to a resolution that was written by one of your resident colleagues at the 2006 Annual Meeting. The AMA (along with comments from other organizations/individuals) participated in the comment period and pointed out the hypocrisy of cutting the educational component out of funding for graduate medical education. In response, CMS changed its ruling so that only if a resident?s workday consists entirely of scheduled non?patient care activities, that workday would not be paid for.

The new rule is still imperfect; rather than fining them, CMS should stand and applaud residency programs that value education to such an extent that they will dedicate a full day for it. And we who stand by this principle will continue to advocate for CMS to value education and its importance to our patients and revise the rule even further. Thanks to the AMA, however, most of the potentially negative impacts of that rule have been mitigated.

Let?s take a moment to celebrate the resident who wrote the resolution, the AMA for following through with its comment, and CMS for making the change. If you are not a member, read this article and join us.

If you are a member, thank you for being a part of the solution. Without this advocacy, your hospital?s finances or your conferences were likely in jeopardy.

Do you still believe that you cannot make a difference? The person who wrote that resolution surely believed residents could make a difference. This is the power of the AMA. Join us. Then submit a resolution, or just come to our meeting to participate?I hope to see you in Las Vegas in November. Together we are stronger, and together we can and will create a better healthcare system for our colleagues and for our patients.

David Rosman, MD, MBA
American Medical Association
House of Delegates
Resident and Fellow Section
Governing Council

American Medical Association-Resident and Fellow Section, 2006-2007 Governing Council
Sunny Ramchandani, MD, MPH, Chair
Kelly Caverzagie, MD, Vice Chair
Douglas Che Miller, MD, Secretary
David Rosman, MD, Delegate
Kimberly Ruscher, MD, Alternate Delegate
Seemal Desai, MD, Member-at-Large
Kusum Punjabi, MD, Member- at-Large
Samantha Cramoy, MD, Resident Trustee
Julie Snelling, Director
Department of Resident and Fellow Services
?Code Blue? is prepared by the Resident and Fellow Section of the AMA. Unless specifically indicated, its articles and opinions do not necessarily reflect the policy of the AMA or the opinions of the editors or the publisher of Resident & Staff Physician. This newsletter is contained in Resident & Staff Physician solely as a service to residents. The journal is not in any way involved in deciding the content of ?Code Blue.? All questions, suggestions, or requests for additional information should be sent to the AMA Department of Resident and Fellow Services, 515 North State Street, Chicago, IL 60610, or phone 312/464-4751. The American Medical Association-Resident and Fellow Section (AMA-RFS) is this nation?s strongest voice for residents and their patients. Visit our Web page at To join or renew your membership, call the AMA-RFS at 800/AMA-3211.

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