Deborah L. Benzil, MD, FAANS
Editor’s Note: To read another perspective on funding neurosurgical resident salaries, read “Counterpoint: Why Government Should Fund Neurosurgical Residency Training.”
Too much of health-care funding is indirect and thus impossible for broad understanding by most physicians and health-care administrators, let alone the public. This stands in stark contrast to most business enterprises (even complex ones) in which all parties of a commercial or educational interchange understand the parameters: e.g. tuition payment for a given course or credits; homeowner’s insurance premiums for coverage over a defined period (with deductibles, exclusions and ceiling for replacement). The same cannot be said for most of the medical care currently delivered and received within the United States. Funding of resident education exemplifies this highly dysfunctional process. Currently, the following morass applies:
- Medical schools have oversight of education activity (known as graduate medical education, GME).
- Hospitals receive two separate pools of money through Centers for Medicare and Medicaid Services (CMS) to support the costs predicted to be incurred by hospitals that do residency training (direct graduate medical education, DGME, and indirect medical education, IME).*
- Residents receive salaries (and these days usually reasonable benefits) either through the hospital (most often) or a medical school (sometimes a combination).
- (Neurosurgery) Departments receive funds from either the medical school or hospital to support the massive administrative and educational program mandated for resident education (through resident review committees (RRCs) and the Accreditation Council for Graduate Medical Education (ACGME)).
- Through all of our taxes, we pay a portion of our Medicare dollars toward resident education (whether we use this care or not).
When the resident system first evolved, the apprenticeship model was heralded as having dramatic educational merit over other less-exacting systems….READ THE REST HERE