Prior to 1965 when physicians graduated from medical school and proceeded on to an internship or residency program, they were fortunate to get room and board. It was a struggle, but a necessary one. Many physicians went into what was then considered “General Practice” in order to save enough money to obtain further training in a specialty of interest.
As the Johnson administration developed the Medicare program, it was decided that the government would subsidize graduate medical education, believing that would assure an adequate workforce to care for our aging population in the years to come. Taxpayer dollars subsidize young doctors through their training. With geriatricians amongst the lowest paid of all physicians, most young doctors choose to take advantage of these subsidies and continue on to train in high paying specialties. Fewer than 7,000 physicians are now board certified in geriatric medicine, and that number is going down every year!
Today, the Medicare Trust Fund spends over $10 billion a year on graduate medical education. Remarkably, very little of this money is dedicated to teaching doctors how to care for older adults. There is no accountability to the seniors and their families who pay Medicare taxes. A recent report couldn’t even determine what $3 billion a year of these funds was actually spent on.
At a time when congress is calling for value based purchasing and evidence based medicine, what value are we getting for the $10 billion a year spent by the Medicare Trust Fund? Indeed, many of the expensive procedures and medications used by specialists caring for older adults have not been studied in people over the age of eighty. Geriatricians and Geriatric Interdisciplinary teams, on the other hand, tend to take a high touch, low tech approach to care that patients and their families appreciate and has been shown to provide quality and cost effective care.
The cost of Medicare keeps rising every year. Congress has a huge opportunity to impact the quality and cost of care without spending an extra dime. They can require that the money spent on graduate medical education be used primarily for the education of physicians, nurse practitioners, physician assistants, nurses, pharmacists, social workers, psychologists, physical, occupational and speech therapists in the core competencies of caring for seniors. We can no longer afford subsidize the development of expensive, procedurally based care with dollars that were meant to develop the workforce necessary to care for our seniors.
Healthcare reform was made up of over a thousand pages of workarounds for a broken health care system. If Congress is serious about value and accountability, they’d start by reforming how our Medicare tax dollars are spent on educating our healthcare workforce. If they don’t, then how can we believe they’re serious about actually trying to fix a broken system?