Fulfilling a 1996 legislative mandate, New York State Health Commissioner Barbara A. DeBuono has awarded $45 million to 67 hospitals that trimmed the number of residents in their graduate medical education training programs and increased the proportion of primary care residents in 1997. The awards, part of a $54 million incentive pool created by the Health Care Reform Act of 1996, are the first phase of a three-year program designed to encourage hospitals and hospital consortia to adapt their physician training to reflect the state’s changing health care priorities. An additional $8 million will be awarded to training programs that increase the proportion of under-represented minorities later this year.
The GME Reform Incentive Pool provides financial incentives for programs that support goals to train more primary care physicians, to include underrepresented minorities, and to maintain the quality of training while reducing the overall number of medical residents. To qualify for the awards in 1997, hospitals and consortia had to prove that at least 95 percent of their medical residents were in accredited programs and that the number of graduate medical trainees enrolled in their programs dropped by 2 percent or more. In 1997, the 67 hospitals that qualified for the awards eliminated 925 residency slots and shifted 1,156 specialty residency slots into primary care.
In 1998 and 1999, incentives to meet other goals will be added, including increasing the proportion of residency training in ambulatory care sites, graduates practicing in underserved areas and graduates from primary care residency programs who remain to practice in the states.
Thomas F. Burke, executive director of the New York State Council on Graduate Medical Education, says the program is separate from, but complementary to the goals of the Health Care Financing Administration (HCFA) graduate medical education demonstration project, implemented last summer. Over a period of five years, HCFA’s project is expected to reduce the number of training positions in 42 New York State teaching hospitals by 20 to 25 percent. Half of the hospitals that qualified for the state’s incentive awards were also taking part in the HCFA demonstration project.
The jury is still out on the impact the program will have in teaching hospitals and consortia, says Burke. "A report card on the success of the program is premature at this point. We haven’t seen any drastic results from this program," he says, adding that many of the qualifying hospitals and consortia had a large pool of residents from which to downsize. The effects may be more pronounced in smaller programs.