Financial Problems at Academic Medical Centers ‘Straining’ Attempts to Train Doctors
Budget problems at many academic medical centers have "strain[ed]" their attempts to train new doctors, according to a report from the Commonwealth Fund Task Force on Academic Health Centers. AHCs, hospitals that provide training to medical students, receive federal money through Medicare, which at one time paid hospitals more than the cost of care, providing them a "cushion" that could be used for education, the Boston Globe reports. However, after the Balanced Budget Act of 1997, those payments declined and now "fail to cover costs." With many AHCs losing money, faculty members "feel pressure" to spend more time treating patients and seeking research grants rather than training students (Barnard, Boston Globe, 5/16). The report also notes other factors making it difficult for AHCs to fulfill their education mission, including the "significant decrease in hospital use and length of stay," which means that students often do not have enough time to learn from each case. The report also notes that as more patient care shifts to ambulatory care settings, deans at AHCs have "difficulty" recruiting physicians to teach students in such settings. Further, the clinical workloads of teaching faculty have increased, leaving less time for teaching. In addition, the report notes that there is evidence that a hospital's per-patient costs are related to the amount of teaching it performs. For example a Commonwealth Fund study by Lewin Associates found that nonteaching hospitals spend $5,034 per patient, while hospitals with the "greatest intensity of teaching" spent $10,655 per patient (Commonwealth Fund release, 5/15).
The report recommends in part that AHCs more effectively measure their performance. However, the Globe reports that "measuring the effectiveness of education is difficult," because the only "universal" measure of the quality of an AHC's education comes in students' scores on medical licensing or board-certified specialist exams -- "tests that measure minimum competency rather than true skill" (Boston Globe, 5/16). "The fundamental rationale for the existence of Academic Health Centers is the education of the nation's health care workforce, yet we have no way of measuring how well they are performing this task," task force Executive Director Dr. David Blumenthal said. Blumenthal also is the director of the Institute for Health Policy at Massachusetts General Hospital/Partners Healthcare (Commonwealth Fund release, 5/15). The task force suggested that the federal government create a $25 million fund to develop measures to evaluate AHCs (Boston Globe, 5/16). The report also recommends that AHCs find ways to encourage faculty to spend more time teaching and increase efforts to recruit minorities and prepare physicians for increasingly diverse patient loads. The final task force report is due next fall (Commonwealth Fund release, 5/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.