Canadian Health&Care; Mall

Hospital-based health care delivery in the United States traditionally has relied on the services of physicians in training, commonly referred to as house staff or house officers. The existence of large numbers of house staff to provide inpatient care may, however, decline. The reasons for this are varied. First, the Graduate Medical Education National Advisory Report estimated that the United States will have a surplus of70,000 by the year 1990 and 145,000 by the year 2000. It recommended freezing the number of trainees in internal medicine and reducing subspecialty trainee positions by up to 20 percent and medical students by 17 percent. Based on this, many medical schools already have decreased the size of their classes and residency programs. Second, funding for house officers is becoming less readily available. Congressional committees are considering budget cuts for postgraduate medical training. Congress recently enacted the Consolidated Omnibus Budget Reconciliation Act of 1986 in which Medicare reimbursement for the indirect costs of medical education were reduced. Many hospitals are now relying on revenues from patient care to compensate for these losses. However, with the implementation of the DRGs in 1983, this source of revenue may be curtailed. Finally, the supply of FMGs willing to fill the gap left by the decreasing number of US trainees may decline. Funding for foreign graduates is more difficult to obtain and Medicare funds to programs hiring FMGs may be cut.