Saving Money on Trainees

With the recent economic crisis, there have been proposals to cut federal funding to residency programs. Obviously, I have a vested interest in this topic, and I think that without revamping the medical training system in the United States, this is a very dangerous idea. Medical residents are paid by the government as a result of the Medicare bill. Hospitals get reimbursed for the residents they train. Certainly, cutting this source of funding would save money on the government's part, but without funding, residency programs will collapse. We are not overpaid. For the hours we work, the years we train, and the responsibilities we carry, our salaries are hardly excessive. In fact, when an anesthesiology resident graduates and goes to private practice, he can make six times his prior salary. (Whether anesthesiologists are overpaid is a separate topic). Furthermore, residents have a heavy debt load after four years of undergrad and four years of medical school. It would simply be unsustainable for us not to make money. Few hospitals would be able to salary residents without federal support. As a result, trying to save money with training programs hamstrings those programs and would stop our supply of new physicians.

Now, there are proposals of bigger changes - perhaps revamping the entire system would be better - cut the costs of going to medical school, and in return, pull back on the salaries for residents. I don't know how such a big change would work. Certainly, medical schools do not depend on tuition for the bulk of their costs, but having gone to a state school, I know how tight finances are. And cutting income for residents later on puts pressure on them in a time of their life when they are looking to start a family, buy a house, etc. Only a well-tested and piloted program would be feasible, and in the end, I'm not sure that's where the biggest savings will be.

I understand the dilemma. The federal debt seems insurmountable without touching health care as an expenditure. No one wants to take away from the beneficiaries of Medicare, Medicaid, and other programs. But to take away from physicians-in-training is to take a large risk for little yield.