Feds could pay HUP not to train residents

The University receives nearly $1 million daily in federal funds, but in the near future, it may get money for a new reason altogether -- as an incentive not to teach students. Medical School officials said a new federal policy designed to reduce a "glut" of doctors might limit the number of residents trained at Penn in the future, but no current residents will be affected. Republican members of Congress slipped a clause into the 1997-98 budget capping the number of residents a hospital can train and offering financial incentives to teaching hospitals which voluntarily cut residency positions. The Medical School has not yet decided whether to eliminate any positions under the program, which offers subsidies to hospitals that cut 20 percent of their residency positions by 2002. A decision is expected within the year, according to Chief Medical Officer David Shulkin. Under the program, teaching hospitals will receive $100,000 for each doctor not trained in the first two years following the elimination of each position, and reduced amounts in successive years. The admittedly bizarre initiative represents an attempt to reduce the number of American doctors, particularly specialists. With more than 700,000 physicians, the U.S. has more doctors per capita than almost any other country in the world, and some wonder whether they're all necessary. The program prevents participating hospitals from increasing the number of residents above their levels as of Dec. 31, 1996. Hospitals, however, are free to add residents to their primary care programs, as well as to any newly created departments. The University's family practice and emergency medicine departments will be allowed to continue adding residents because they were still being developed at the end of 1996, Shulkin said. In addition to capping the number of residents hospitals can train, the federal government is also offering subsidies to hospitals which voluntarily eliminate resident positions, according to Ari Fleischer, a spokesperson for House Ways and Means Committee Chairperson Bill Archer (R-Texas). Subsidizing hospitals for agreeing not to train doctors is "good policy for the nation," Fleischer said, adding that "it remains a voluntary matter of choice for teaching hospitals." The University faces a tough decision on the reduction incentives because Penn places "a very high value on our graduate training programs and we are in the process of considering the options," Shulkin said. Shulkin will soon meet with representatives from the Medical School departments that have residency programs to evaluate the program, and expects a decision on whether Penn will participate "within the year." "It will be an institutional decision, but the primary motivator will be what is best for each specific training program," he said. Several current residents said they were relieved that they would not be affected by the new program, but expressed concern about the implications of such a program on the future of medical training at the University. "Penn has long been a place that has prided itself on subspecialty training, but that tradition will be lost if the focus moves toward training primary care physicians," Internal Medicine resident Parker Ward said. And Shulkin cautioned that "doctor glut" is a complex issue which will "take years to sort out." "It is an oversimplification to just say there are too many specialists," he said. "There are some areas of the country still grossly underserved by specialists, while others have too many."