Federal cuts would put city hospitals on life support


This week, more than 3,000 new medical school graduates begin their resident training in 121 teaching hospitals throughout New York State – the overwhelming majority of them in the New York City area.

New York’s teaching hospitals train three out of four doctors practicing in our state – but do far more than that; they prepare more than 16,000 medical and surgical residents every year, fully 17% of all physicians trained in the nation. No other place in the world trains more doctors in more specialties.

Not surprisingly, teaching hospitals are also critically important to New York’s economy – especially at a time when every week seems to bring a gloomier financial forecast. A study by the Association of American Medical Colleges found that graduate medical education contributes a total of $66 billion and 450,000 jobs to the state, almost double that of the next closest state, Pennsylvania.

So it is puzzling to say the least that the federal government is poised to make a decision that would decimate these institutions, dealing a massive, double blow to our health care infrastructure and to our economic health.

Yet that is precisely what the Bush administration is set to do. It is trying to enact a regulation that would eliminate all Medicaid support for physician training. That’s right, all of it. Yes, if the administration gets its way, the hospitals may still receive some funding from other federal sources – but Medicaid, a reliable and critical source of support for more than 40 years, would dry up completely.

That one change would cost our teaching hospitals more than $1 billion in vital funding annually. This will undercut the ability of these institutions to train tomorrow’s doctors – and send shock waves throughout America‘s medical community and all those who depend upon it.

The administration’s decision makes so little sense that we can only assume it’s nothing more than a cost-saving measure. Without that funding, New York’s teaching hospitals would have no choice but to sharply curtail services, and New York’s most vulnerable residents – the poor and uninsured – are sure to suffer the most.

The timing could not be worse. Despite New York’s work in training so many medical residents, the U.S. is nonetheless on the brink of an alarming physician shortage that will coincide with the medical demands of the retiring baby boomers – a true health care “perfect storm.” The AAMC expects a shortage of at least 55,000 physicians by the year 2020.

Given the amount of time it takes to educate and train a physician – four years of medical school plus multiple years of residency training – 2020 is right now.

You do not address a looming physician shortage by drastically weakening the very institutions that do the training. This is the equivalent of a city addressing a violent crime wave by stripping its police officers of firearms, handcuffs and radios.

Everyone knows that health care costs are through the roof, especially in New York State. That not only squeezes the budgets of ordinary Americans but strains hospitals – which are struggling to keep costs down while constantly investing in quality. Operating a teaching hospital is a costly proposition. They must constantly adopt the latest medical technologies and practices, serve disproportionate numbers of poor and uninsured patients and provide undercompensated but critical services such as trauma centers and burn units.

If New York is to remain the vibrant hub of America’s medical education community, Congress must find a way to block the Bush administration’s push to eliminate Medicaid graduate medical education funding. Our future health – and the assurance that New York will welcome 3,000 new medical residents this time next year – depend on it.

Raske is president of the Greater New York Hospital Association.

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