So I conceded I strongly disagree with lifting the Medicare GME cap. Congress limits the amount of **Medicare funded** GME slots, not overall residency slots. In fact, all the evidence that I have seen shows that the cap on Medicare GME slots did not change the trajectory in the growth of residencies - hospitals still have an incentive to add residency slots because residents are effectively cheap labor. https://www.nejm.org/doi/full/10.1056/NEJMp1402468
Furthermore, Medicare GME is exceptionally inefficient. It was not designed in a way to incentivize the growth in residencies - it was simply a payoff for teaching hospitals to continue participating in the Medicare system when the changes was made to DRGs in 1983. https://paragoninstitute.org/public-health/shortages-in-the-health-care-workforce/
If anything, we should look at the monopoly of residency accrediting organizations and how that is a bottleneck to new residency programs and slots.
I had no idea that this is how residency is financed, nor that it was limited by the government.
An immediate question that comes to mind: how did we end up with this system? Why is the government paying for residency--and, maybe even more fundamentally, how did these very long, required residency programs even come about? Are they needed to ensure quality care?
I'm also curious how other countries handle this cost and capacity for residency program problem. Obviously, no-where is there a free market, but as in your long-term care article, it's often helpful to know what else has been tried elsewhere. (You may have written about these questions somewhere; I haven't made it through all your long list of articles yet.)
So I conceded I strongly disagree with lifting the Medicare GME cap. Congress limits the amount of **Medicare funded** GME slots, not overall residency slots. In fact, all the evidence that I have seen shows that the cap on Medicare GME slots did not change the trajectory in the growth of residencies - hospitals still have an incentive to add residency slots because residents are effectively cheap labor. https://www.nejm.org/doi/full/10.1056/NEJMp1402468
Furthermore, Medicare GME is exceptionally inefficient. It was not designed in a way to incentivize the growth in residencies - it was simply a payoff for teaching hospitals to continue participating in the Medicare system when the changes was made to DRGs in 1983. https://paragoninstitute.org/public-health/shortages-in-the-health-care-workforce/
If anything, we should look at the monopoly of residency accrediting organizations and how that is a bottleneck to new residency programs and slots.
I had no idea that this is how residency is financed, nor that it was limited by the government.
An immediate question that comes to mind: how did we end up with this system? Why is the government paying for residency--and, maybe even more fundamentally, how did these very long, required residency programs even come about? Are they needed to ensure quality care?
I'm also curious how other countries handle this cost and capacity for residency program problem. Obviously, no-where is there a free market, but as in your long-term care article, it's often helpful to know what else has been tried elsewhere. (You may have written about these questions somewhere; I haven't made it through all your long list of articles yet.)