Charles P. Clayton
Health care reform legislation proposed by Democratic leaders of the three committees of jurisdiction in the US House of Representatives would mandate a study of residency education and faculty expertise in subjects including patient care coordination, costs and benefits of diagnostic and treatment options, and work in inter-professional teams. The bill would also (1) redistribute unused residency positions to hospitals that agree to expand and maintain primary care training as well as (2) provide legislative authority for graduate medical education payments from the Medicaid system.
The curricular assessment is the most troubling aspect of the bill. The legislation articulates seven goals for physician training, including working effectively in non-hospital settings, implementing solutions to health care systems errors, and being “meaningful [electronic health record] users.” The bill does not mention development of medical knowledge or skills as goals for training. According to the bill, the aforementioned study, to be conducted by the Comptroller General, would include recommendations in two areas. First, the report would discuss if making curricula in the seven goal areas mandatory for Medicare graduate medical education payments would be effective in changing medical education. Second, the report would discuss if existing accrediting processes are effective in changing curricula to meet the goals outlined in the bill.
Among other provisions, the bill would also expand the National Health Service Corps, create new Health Professional Needs Areas and programs to address shortages in these areas, and reauthorize the medical education programs administered by the Health Services and Research Administration (commonly referred to as the Title VII programs).
Of the three legislative drivers for health care reform, the so called “tri-committee” process in the House appears least well positioned to affect the final legislative package. The House bill has little support from Republicans, and President Barack H. Obama and Senate leaders have called for any final legislation to have bi-partisan support. With a price tag finally pegged at under $1 trillion over 10 years, the eagerly anticipated bill from the US Senate Committee on Finance, chaired by Senator Max Baucus (D-MT), will likely be the principal vehicle for moving forward health care reform. Hearings on this bill are expected to begin after the July 4 holiday congressional recess.
The Alliance for Academic Internal Medicine will make a side-by-side analysis of the medical education sections of the three major bills available in July once the Senate Finance Committee legislation becomes available.