Paying hospitals not to train doctors

September 09, 1997|By Daniel S. Greenberg

WASHINGTON -- Don't expect anything but a hemorrhage at the Treasury from that new program to counter the doctor surplus by paying hospitals to reduce the number of residency slots for the final phase of medical training.

Reminiscent of the agricultural-support schemes that paid farmers for not growing crops, the medical plan was inspired by pTC an immutable law of American medical practice: More doctors mean more medical spending, despite the penny-pinching tactics of managed care. So, stop them before they can start hustling patients, the Washington strategists concluded.

The medical-education industry, however, is too profitable, inventive and resilient to yield to that tactic.

The major factor in the medical-production pipeline is medical-school enrollments. Data compiled by the American Medical Association show that these have remained virtually unchanged for over 15 years, as have the number of medical schools. In fact, medical schools have supplanted military bases as immortal institutions.

In 1980-81, the 124 medical schools in the United States enrolled 65,497 students; in 1996-97, the number of schools remained at 124, and enrollments stood at 66,712 -- though a long succession of studies proclaimed a surfeit of doctors.

The big change in medical education was a vast increase in revenues, much of it from so-called practice plans that pay medical faculty for attending to patients, usually in conjunction with their teaching duties. Over the past decade, this income total for faculty at the 124 schools has risen from $5.2 billion to $10.6 billion.

And, in accord with the Willie Sutton principle, the number of full-time faculty has soared, though the number of students remains almost unchanged. In 1983-84, the nationwide faculty totaled 56,564. In the current academic year, the number of faculty members is 95,568.

Where are they coming from? To a large extent, they were already there at the university on other payrolls, and were switched to the more bountiful cash flow of medical education, which draws on patient fees, federal research and ample loans to finance runaway tuition fees -- to be repaid by high medical incomes.

A little-known fact of American higher education is that the highest-paid people on many prestigious campuses are not university presidents. The big bucks go to the medical-school professors.

At Columbia University, according to the Chronicle of Higher Education, the president was paid $317,187 in 1994-95, while one professor of surgery received $1,526,397 and two others took in more than $1 million apiece. At Cornell, the president received $294,687 in pay and benefits in 1994-95. A professor of surgery at Cornell received $1.7 million in pay that year, while two others each took in more than $1.2 million. The president of New York University was paid $379,000. The chairman of neurosurgery got $748,342, while four other medical professors received more than $600,000 each.

At universities without medical schools, pay scales don't approach these stratospheric medical incomes. At Princeton, for example, the presidential pay was tops, at $305,538, and the next five highest salaries ranged between $197,796 and $240,713. At MIT, the president received $285,000, and the next highest salary was $236,000,

The medical-school industry, in alliance with local politicians, is eternally resistant to downsizing pleas. The Pentagon wants to close the medical school that was forced on it by the Congress in 1972, the Uniformed Services University of the Health Sciences, in Bethesda. The General Accounting Office says the school is excessively expensive and satisfies only a tiny proportion of the armed services' physician requirements. But the school survives.

The Washington lobby for medical schools, the Association of American Medical Colleges, says the solution to the doctor surplus is to exclude foreign-trained physicians from residency slots. The downside to that prescription is that foreigners are willing to train and practice in inner-city areas that home-grown physicians tend to shun.

But whatever is done in the quest for surplus reduction, the odds are that it won't work. The medical-education industry is too smart and well-connected to be deprived of its golden goose.

Daniel S. Greenberg publishes the newsletter Science & Government Report.

Pub Date: 9/09/97

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