Q&A

Threats to cut federal Medicare funds that pay for residency training for doctors have eased but not gone away since they were formally proposed by some members of the Congressional super committee last fall.

Dr. Peter Nalin, the associate dean of graduate medical education at the Indiana University School of Medicine—which funds more than 1,100 residents at any given time—said such cuts would be disastrous at a time when patient demands increasingly outstrip the supply of physicians.

IBJ: Some deficit-cutting plans called for reducing by as much as 30 percent the $10 billion in annual Medicare funding for the residencies that medical school graduates do in hospitals, before they practice on their own. What impact would those cuts have had here in Indiana?

A: It would have an immediate impact because the residents and fellows are a first source of access to care for many patients: emergency, family medicine, geriatrics. The residents and fellows deliver care in clinics and offices and the emergency room, so often it’s a resident or fellow—of course conducting clinical work under supervision—that helps the system see tens to hundreds of thousands of patients in a year. The replacement cost of all of that activity … would far outstrip the savings and investment that occurs.

IBJ: Why couldn’t the IU medical school absorb those cuts and keep funding residency training?

A: This wasn’t going to be just trimming around the edges. This was going to be cuts to the core of the system. We’re in a decade of expansion of 30 percent nationally in enrollment in medical schools. There needs to be a 30-percent increase in [graduate medical education] funding, too, if we’re going to train more doctors.

IBJ: Has the IU medical school developed a contingency plan for dealing with such cuts, should they come to fruition?

A: Even the severest cuts that were proposed were going to be phased in over a number of years. If such severe cuts were to occur, we would have to inventory our deployment of every resource to figure out what that impact would be. It would have involved both the medical school and all the health systems with which we work. So far, we have had only preliminary discussions.