Funding caps limit doctor education in Iowa

IOWA CITY (AP) - One minute, Susie Hagen is performing surgery on a motorcycle accident or gunshot victim and the next it's on a patient with a thyroid condition or colon cancer.

As a fourth-year University of Iowa Hospitals and Clinics resident physician, Hagen has to be flexible. She usually works six days and up to 80 hours a week and mixes in educational conferences. This training is essential to launching her career as a surgeon.

"It is the only way that I can become a board-certified surgeon," said Hagen, 35. "I am not allowed to do surgery independently right now. I need to be supervised."

Resident physicians at UIHC and elsewhere are key to patient care today, and they represent the medical work force of the future. The problem is a federal funding cap limits training at teaching hospitals, some industry professionals say.

"Reimbursement from Centers for Medicare & Medicaid Services for graduate medical education to UIHC is much less than the costs of running this crucial mission for our institution to train the next generation of outstanding physicians," said Mark Wilson, the director of Graduate Medical Education program at UIHC.

UI has 700 residents, but is only reimbursed for 410, Wilson said. That translates to a $6 million gap between the $15 million a year in direct reimbursements UI receives and the $21 million UI provides in resident stipends, Wilson said.

The Association of American Medical Colleges is lobbying to increase the funding cap for graduate medical education by 15 percent for direct and indirect costs, said Christiane Mitchell, director of federal affairs for the association. That would yield about 5,000 more physicians, which is not a lot but a good place to start, she said.

The current cap was established more than 10 years ago, and it no longer reflects the need, she said. AAMC projects a shortfall of 125,000 physicians in the U.S. by 2025.

"Basically, we need to relook at the physician work force of the future and the demand on that work force and make sure there are enough doctors to meet that demand. Based on our analysis, there will not be enough doctors to meet that demand," she said.

Legislators are sympathetic to the need, but money is tight, she said. It would cost about $15 billion to expand the graduate medical education program, she said.

Stacey Cyphert, UIHC assistant vice president for health policy, travels regularly to Washington, D.C., to support health care needs for UI.

"This continues to be an issue that we would like to see addressed. Many teaching hospitals support residents over their cap, so it is bigger than just UIHC. Exactly what can be accomplished in this regard remains to be seen as there are numerous elements under consideration in the renewed debate on health care-related reforms," Cyphert said.

Wilson is optimistic something can be done, he said.

The question for UI is whether they would receive support for the uncovered positions, or whether they would have to expand the program to see more reimbursement, Wilson said.

"For Iowa, it would be best if funding could apply to situations where we are already over our funding cap. In early drafts, it would support only new expansion positions," he said.