If you or someone you love were gravely ill, where would you turn?
Chances are, you thought of an academic medical center. Across the country, these institutions — which consist of the nation’s medical schools, teaching hospitals and their faculty physicians — provide the world’s most advanced medical care to patients diagnosed with serious or rare illnesses, as well as those who can’t find out what’s wrong with them. They also provide standby services, such as trauma and burn care, that must operate around the clock in case patients need them. With the best physicians and facilities in the world, academic medical centers are where patients, their families and other health care providers turn to find hope.
Over the past century, these institutions have served as hubs of innovation that have transformed the practice of medicine and dramatically improved our nation’s health. Physicians and scientists at these institutions have pioneered advancements that are now staples of clinical care, including intensive care units for newborns; new and better treatments for diabetes, cancer and heart disease; new technologies, such as joint replacements, that improve quality of life; and organ and bone marrow transplantation. Much of this work is supported by grants from the National Institutes of Health and other sources of federal funding.
In addition to providing the world’s most advanced medical care, teaching hospitals educate and train the next generation of physicians and almost every other type of health professional. Every year, more than 16,000 graduates of the nation’s 130 medical schools begin their residency training at U.S. teaching hospitals.
This period of graduate medical education, which ranges from three to more than eight years after medical school, provides new physicians with the clinical experience and knowledge they need to become effective and highly qualified doctors. New physicians train in a variety of clinical environments that expose them to all that modern medical care and research has to offer while helping them to become lifelong learners — an essential skill with medical knowledge doubling every seven years.
Physicians at teaching hospitals also play a critical role in primary care and prevention. Frequently, they provide primary and specialty care to patients who have multiple complex conditions. They also conduct research on chronic illnesses, and they test and implement new care models, such as the medical home, that help patients better navigate a complex system. Teaching hospitals are also frequently the only source of community services aimed at improving health, such as providing nutrition counseling and geriatric services.
Although “major— teaching hospitals (those with the most intensive training programs) account for only 6 percent of all acute care hospitals, they provide 22 percent of services to Medicare beneficiaries, 28 percent of all Medicaid care and 41 percent of all hospital-based charity care in the country, making them an essential part of the nation’s health care safety net.
All of these important, societal missions have a cost. Medicare and Medicaid have recognized the role of medical schools and teaching hospitals in advancing American health care for more than 40 years. Historically, both programs have supported their share of the costs of training physicians and sustaining an environment where training, medical research and the most advanced patient care occur.
Yet since passage of the Balanced Budget Act in 1997, Medicare has severely restricted the level of support it provides for physician training and the unique clinical environment maintained by teaching hospitals. While this action may have made sense when a physician surplus was predicted because of managed care, 12 years later it has contributed to physician shortages across the nation, including those in primary care. These shortages are likely to get worse, not better, as the United States moves toward expanded health insurance coverage and the baby boomers double the number of Americans over age 65.
As discussions about health care reform advance, it is vital that Medicare and other payers support their share of the training, the innovation, and the life-saving care that teaching hospitals and physicians provide to their communities. The Resident Physician Shortage Reduction Act (S. 973/H.R. 2251), recently introduced in Congress, would restore Medicare’s support for physician training and vital services that only teaching hospitals can provide.
America’s health care faces a crisis of cost, access and quality. As we move forward toward a better system that improves the health of all Americans, we must expand access and strengthen the aspects of the system that have set the standard for the rest of the world. While the rate of cost growth must be reduced, reform must not destabilize the institutions that provide vital and unique services to communities across the country and, perhaps most importantly, provide hope to each of us when we need it most.
When you or your family member becomes gravely ill, where would you turn if that hope was lost?
Atul Grover, M.D., Ph.D., is chief advocacy officer at the Association of American Medical Colleges.