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?
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.
February 28, 1997
To the Editor,
The New York Times Company,
229 W. 43rd Street,
New York, N.Y. 10036-3959
Referring to your editorial “Fewer Doctors, Lower Medicare Costs,” of Friday, February 28, 1997, this looks very nice on paper. The reality is that human beings are dying in Teaching Hospitals in New York State due to varying degrees of medical negligence. In some cases, this negligence is criminal.
Three and one half years ago, in August of 1993, while our son was in The Columbia Presbyterian Allen Pavilion, when the nurses called for the Doctor to respond at night, no one came. The intern, 2 months out of medical school, was “unavailable” despite the fact that our son was deteriorating medically. This, plus numerous other acts of medical negligence resulting from absent supervision, led to his death.
As you point out “residents bear the brunt of treating uninsured, often indigent patients in many urban neighborhoods.” If even these insufficiently supervised trainees are reduced in numbers, who will then take their place? Patients, particularly minority patients, are well aware of the risks they face in going to “Teaching Hospitals” for their care. Most are not able, as we were able, to read a chart in order to understand just how abysmal this care can be.
In the year 1984, almost 7,000 patients lost their lives in hospitals in New York State due to negligent acts which were unrelated to the medical reasons that brought them to the hospital ( Adverse Events and Negligence in Hospitalized Patients, New England Journal of Medicine, February 7, 1991,Volume 324, No.6, Page 373). This is 133 lives each week, 52 weeks each year. This is how and why our son died.
Human life is the bottom line, not money. The Health Care Finance Administration-Greater New York Hospital Association deal will finally legitimize poor care, insufficient care, and no care if there are no built in conditions about just how this money is to be spent. HCFA has claimed there are “built in requirements” to get this money. What are these “requirements.”? Hospitals should not be permitted to build parking lots or develop better television ads with this money. Otherwise, doctors and institutions will be rewarded monetarily at the cost of even greater human suffering and death than exists now.
Stephanie Z. Speken, M.S.
Ralph H. Speken, M.D.