Heal yourself

Seek a quicker fix for lagging graduate medical funding

There are few things less maneuverable than the inertia of a federal government program.

From 2000 to 2012, Georgia’s population rose by 2.4 percent, making it the nation’s ninth-fastest-growing state. Meanwhile New York state, like many of its Northeastern neighbors, grew by barely 1 percent – ranking it 32nd in growth.

Yet the rules Medicare uses to divvy up $10 billion per year in spending on graduate medical education are based on a formula that hasn’t been tweaked for more than a decade. That means Georgia’s growing population is facing an increasing shortage of physicians worsened by a lack of residency funding, while New York has a glut of spaces – and a greater likelihood of keeping the doctors once they’re trained.

That’s the gist of a recent story by The Augusta Chronicle’s Tom Corwin and Sandy Hodson, which finds that New York receives a whopping 20 percent of Medicare’s funding to support graduate medical education, while Georgia and other states receive barely a 1 percent share.

Dr. Fitzhugh Mullan, Murdock Head Professor of Medicine and Health Policy at George Washington University and a lead author aid on the study, found that New York receives $103.63 per capita in residency funding compared to $14.114 for Georgia. While Georgia has 3.1 percent of the U.S. population and 2.4 percent of U.S. medical students, the state receives just 1.36 percent of the total residency funding.

“That’s a pretty dramatic story,” he said.

Indeed it is. And because roughly half of all medical students stay to practice in the states where they serve their residencies, the disparity in funding puts Georgia in a self-defeating position of training doctors who then are exported to other states richer in residency positions.

With that looming doctor shortage, and an overall aging population that will require more medical care, that’s a brain drain Georgia can’t afford.

The rational solution would be to reconfigure the Medicare formula, first written in 1983 and revised in 2000. It’s long overdue, and would be a good step toward reversing the decline in physician numbers where census trends clearly show the greatest future need.

But because that requires action from a federal government that can’t even diagnose a website, don’t hold your breath for that change anytime soon.

A more likely solution to the disparity, says Dr. Peter Buckley, dean of the Medical College of Georgia, is for the state to bite the bullet and fund more residency positions to keep up with growing medical school enrollment. That would cut down on the number of physicians trained here and exported to other states for residencies – in most cases, never to return to practice here.

For a long-term cure, congressional action to change the Medicare formula is needed – and perhaps additional residency support funding to keep up with the rising need.

Because Georgia can’t expect fair treatment anytime soon from the grindingly gridlocked federal government, the state should take a cue from MCG and its revived partnership with University Hospital. While the numbers are small in comparison to the overall problem, the residency spots University once again is offering are a good example of cooperation designed to find a solution.

There’s a novel idea. Georgia, don’t wait on the feds to take action; heal yourself.

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