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Federal Funding Inequity Hurts Doctor Training

May 03, 2003|Gail V. Anderson Jr. | Gail V. Anderson Jr. is medical director at Harbor-UCLA Medical Center and assistant dean of the David Geffen School of Medicine at UCLA.

Lost in the publicity about the Los Angeles County public health-care system's continuing fiscal challenge is a serious inequity in federal funding of the county's renowned physician-training programs.

The county's public teaching hospitals -- Harbor-UCLA, County-USC, King-Drew, Olive View-UCLA and Rancho Los Amigos -- not only are critical parts of the health-care safety net but also are important sources of well-trained doctors for our community and nation.

These five hospitals train about 1.6% of the nation's resident physicians each year, yet receive only 0.2% of the annual federal funds for post-medical school training. They receive less than one-tenth the federal dollars per trainee (resident physician) that some hospitals elsewhere in the nation receive.

The basis for this inequity is within the training funding formula. In 1965, Congress tied the federal funding that a teaching hospital would receive to train resident physicians to the proportion of Medicare inpatients treated there.

Then -- as now -- hospitals with high numbers of Medicare inpatients typically received the most federal physician training dollars. In the 1960s, the formula probably made sense as a strategy to entice a skeptical health-care community to accept Medicare patients. But unlike in Medicare's early years, most hospitals today seek the reliable funding they have come to associate with Medicare patients.

The county's public teaching hospitals have the greatest number of patients with no health insurance but a very small proportion (about 6%) of Medicare patients, and therefore receive much less training funding.

The annual national average hospital payment per resident physician is more than $75,000, but our county-operated teaching hospitals receive less than $15,000 on average.

One way to redress this inequity is for Washington to pay us the national average. Such a change would provide upward of $100 million more to the county health system each year.

Another approach, given the importance of the county's public teaching hospitals to regional emergency and disaster preparedness and national trauma training for military surgeons, is to seek funds directly from the departments of Homeland Security and Defense.

Or we can follow the lead of children's hospitals, which have no elderly patients and therefore receive virtually no Medicare training dollars. Recently, they successfully lobbied Congress to annually appropriate funding for post-medical school training of their pediatric residents.

Legislators and other public officials should support increased federal funding for the county's physician training programs, and here's why:

* These teaching hospitals are the backbone of our trauma-emergency system. Their physicians are in the forefront of trauma, emergency and critical care, treating about half of the trauma victims and one-fifth of the emergency patients in Los Angeles.

* The programs are a major source of well-trained physicians for our community.

* The hospitals are crucial to disaster and emergency medical preparedness. In the event of a terrorist act, an earthquake or a public health crisis, these institutions can mobilize scores of doctors within minutes.

Clearly, it is in the best interest of patient care and homeland defense for local, state and national leaders to assist the county in securing equitable federal funding for this vital training.

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