Sick people are at risk in hospitals due to inadequately supervised 
and monitored physican trainees. Seth's case is a tragic example of
this. Due to fiscal constraints, it is now necessary to reduce the 
numbers of even this group of student doctors.  But who will replce them?
     The article below appeared as an editorial in the February 28, 1997 issue
of The New York Times.  The Federal plan is to basically pay New York
hospitals for training fewer physicians.  The key sentence:  "That will 
provide extra money with which to restructure patient care to accomodate
the loss of residents." Who will replace them?  Fully trained attending
doctors who are not adequately supervising trainees now? Perhaps the
replacements will be physician asssitants with even less training.  Who
will supervise them?
                     Fewer Doctors, Lower Medicare Costs
     Hospital officials outside New York are
reacting with jealousy, even rage, to the 
Clinton Administration's plan to pay New 
York hospitals hundreds of millions of 
dollars to train fewer physicians over the 
next six years.  But the anger is misplaced.
The plan is an innovative way to bring 
Medicare costs under control and, in the 
process, better match the nation's supply
of physicians with patient needs.  Rather
than griping that they have been left out, 
teaching hospitals in Boston, Los Angeles
and other training centers ought to root for
New York's success in the hope that what is
good for New York will soon become policy
everywhere else.
     The goal of this demonstration project is
to help reduce a national surfeit of urologists,
anesthesiologists and other specialists.
Hospitals have been slow to stop training 
young doctors, called residents, in such 
specialties because Medicare takes away up
to $100,000 for every residency they cut out
of their teaching programs.  The medical 
community has blocked previous attempts to
cut down on Federal teaching subsidies, in 
part because residents bear the brunt of
treating uninsured, often
   
indigent patients in many urban neighborhoods.
     The prospects for success in the New York 
demonstration are enhanced by the fact that its
provisions were proposed by the hospitals them-
selves. Under the plan, teaching hospitals that
voluntarily cut training slots by about 20 
percent - perhaps 2,000 positions statewide - 
will be allowed to keep over the next six years
about 60 percent of the Medicare subsidies
for the positions that are eliminated. That will
provide extra money with which to restructure
patient care to accommodate the loss of residents.
Washington also comes out ahead because it 
will reap partial savings, worth hundreds of
millions of dollars, over the first six years and
full savings by the seventh year.
     Some critics charge that Bruce Vladeck, a 
New Yorker who heads the agency that 
oversees Medicare, put together a sweetheart
deal.  But budget officials also approved the 
plan. New York is a proper test site because
its hospitals train 15 percent of the nation's
residents and treat many uninsured patients.
If the project cannot succeed in New York, it
cannot serve as a worthy national model.
 
     In reponse to this editorial, we sent the following letter to 
The New York Times.  They did not publish it.
Click for unpublished letter:
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