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November 1996
Volume 60 |
Number 11
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RESIDENTS' REVIEW
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| Managed Care and
Graduate Medical Education |
Scott E. Metzger, M.D., Chair
Resident Component Governing Council
As anesthesiology residents, we are acutely aware of the sweeping
changes affecting graduate medical education. Residency programs
continue to be influenced by various factors, including the decrease
in the number of medical students entering our field, Medicare's
strict interpretation of teaching regulations and changing practice
opportunities. It is clear that managed care is one of the most
influential factors on this dynamic state of resident education.
On September 21-22, the National Consortium of Resident Physician
Organizations (NCRPO) held its Sixth Annual Forum, titled "Managed
Care and Graduate Medical Education: Are They Mutually Exclusive?"
The participants included leaders of specialty societies and state
medical societies as well as recognized experts in public health
and education. Three of the nine NCRPO executive committee members
are anesthesiologists: Paul Barach, M.D., John L. Jimenez, M.D.,
and William K. Kephart, M.D.
John Whyte, M.D., M.P.H., Chair of the NCRPO and the AMA-Resident
Physician Section, began the program with a history of resident
involvement in organized medicine. He shared the podium with Enrique
Fernandez, M.D., Director, Division of Medicine, Bureau of Health
Professions. Dr. Fernandez has been a prominent resident advocate
on the issue of graduate medical education.
The first invited speaker was Arnold S. Relman, M.D., former
editor of the New England Journal of Medicine. He described
managed care as "a revolt of payers (employers)." Dr.
Relman stated that he believed we will ultimately see the triumph
of not-for-profit managed care organizations that offer educated
consumers (patients) a standardized product. The second speaker
was Alan L. Hillman, M.D., Associate Dean for Health Service Research
at the University of Pennsylvania School of Medicine. Dr. Hillman
stated that society has not yet called health care a common good,
like national defense. He also noted that there are several new
trends in managed care such as monitoring patient satisfaction,
reviewing patient records and evaluating care by more subjective
factors. Drs. Relman and Hillman, both of whom are well-connected
politically, had a very lively discussion on the future of managed
care and residency training.
John A. Talbott, M.D., past president of the American Psychiatric
Association, also spoke at the NCRPO. According to Dr. Talbott,
"Managed care is like the jungle in Vietnam. If you get lost,
it can kill you. Otherwise, it can be your friend." He subsequently
described the many ways that managed care affects the way our
patients receive health care. The common themes addressed by all
participants was that residents need to understand the mechanisms
of managed care and need to stay informed on medical care issues
at the local and national levels.
Participation in NCRPO provides an excellent opportunity to see
how other specialties are affected by changes in health care delivery
and to speak with future leaders in the medical field. The quality
of speakers who participated in this year's forum was impressive.
By the end of the program, most residents had a greater appreciation
of the influence of managed care on resident education. A major
disappointment, however, was the paucity of suggestions as to
how interested residents could play an active role in shaping
the future of graduate medical education.
With the expectation of continued change in residency education,
next year's consortium will address active resident participation
in the political process in order to improve health care. "A
Plan for Action" will certainly be included in the title
of the next forum.
Scott E. Metzger, M.D., is a CA-4 Fellow
in pain management at The Johns Hopkins Hospital, Baltimore, Maryland.
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