The Economics of Graduate Medical Education

• Published in: The New England journal of medicine Vol. 370; no. 25; pp. 2357 - 2360
• Main Authors: Chandra, Amitabh, Khullar, Dhruv, Wilensky, Gail R
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 19.06.2014
• Subjects: Economics, Hospital; Education, Medical, Graduate - economics; Financing, Government; Health Policy - economics; Hospitals; Internship and Residency - economics; Internship and Residency - manpower; Internship and Residency - trends; Medical residencies; Medicare - economics; Physicians; Physicians, Primary Care - economics; Physicians, Primary Care - supply & distribution; Primary care; Prospective Payment System; Reimbursement Mechanisms; Salaries and Fringe Benefits - trends; Students, Medical; Training; United States; United States; United States > US
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMp1402468

Economists argue that residents effectively pay the full cost of their training, while their institutions treat federal GME funds as general monies. There are more effective ways to alleviate physicians' indebtedness and encourage doctors to go into primary care. A central health care–related policy question for the United States is whether the federal government's role in financing graduate medical education (GME) increases the number of physicians trained and influences their specialty choices by subsidizing the cost of training. Total federal GME funding amounts to nearly $16 billion annually. Medicare is the largest federal government contributor to GME, providing $9.5 billion — almost $3 billion for direct medical education (DME), to pay the salaries of residents and supervising physicians, and about $6.5 billion for indirect medical education (IME), to subsidize the higher costs that hospitals incur when they run training . . .