A proposed cut to Medicare is really a signal that the federal government should begin reducing its support of medical education and that states should start doing more, Health and Human Services Secretary Michael Leavitt said.

But the head of the group representing U.S. medical schools said such a move would "harm the American health for decades," particularly in light of the need for states such as Georgia to expand medical education to meet a looming doctor shortage.

"The timing could not be worse," said Darrell G. Kirch, the president and CEO of the Association of American Medical Colleges and a former dean of the Medical College of Georgia's School of Medicine.

Mr. Leavitt visited MCG last week and talked to school leaders about a proposed 60 percent cut in the Indirect Medical Education payment Medicare makes to teaching hospitals to help defray the expense of training medical residents. While he acknowledged that Medicaid and Medicare are the primary funding source of medical education now, he said that was never meant to be permanent.

"Schools of medicine years ago went to the federal government and said, 'We're not very stable right now, we've got to have some temporary help from the federal government to assure that we have what we need to train physicians,' " Mr. Leavitt said. "Instead of having temporary help, what happened was it has now become permanent. That can't be sustained."

Instead, the states should be trying to find a way to spread the cost out to a larger number of payers, particularly those hospitals that don't take large numbers of Medicare and Medicaid patients, he said.

"This is basically a call to spread the cost of medical education across the broader spectrum, not one to eliminate it," Mr. Leavitt said.

The assertion that federal support for medical education was meant to be temporary was news to the medical school association.

"I'm not aware of anything in the last 10 years (where) the federal government has given money (with) the sense that it would be a temporary influx of money that would go away," said Karen Fisher, the senior associate vice president of the association's division of health care affairs.

States are already doing their part to fund medical education, Dr. Kirch said.

"They have been willing partners in this process," he said. "But at a time when state budgets are facing their own major challenges, for the federal government to back out of the partnership, it would be very damaging."

Georgia Gov. Sonny Perdue, citing a slowing growth rate in state revenues earlier this year, is calling for $245 million to be cut from next year's fiscal budget. MCG President Daniel W. Rahn said the school is hopeful that $10 million requested to continue planning for expanding the medical school will still pass. The federal cuts would also seem to be at cross-purposes with the school's identified need to expand as quickly as possible.

"For the federal government to be pulling back from support of residency education at the same time, really, I think, represents a malalignment" of purposes, Dr. Rahn said.

It would also have a major impact on teaching hospitals trying to support and expand residency programs, he said. Those hospitals are also dealing with many other problems, Ms. Fisher said.

"There's a tsunami right now on these institutions with these types of cuts on them," she said.

Academic medical centers represent 6 percent of the hospitals in the U.S. but provide 45 percent of the charity care, Dr. Kirch said.

"These hospitals have taken on not just responsibility for training the doctors that will take care of you and me, but they've taken on tremendous social responsibilities for the uninsured and underinsured," he said.

For the federal government to pull back on support could spell disaster, Dr. Kirch said.

"I am wholly dismayed that a long-standing federal-state partnership in support of medical education is now being dismissed as some kind of temporary solution," he said. "To carry through the proposed changes would have effects that would harm the American health for decades in the future."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.