American College of Physicians: Internal Medicine — Doctors for Adults ®


Report targets Medicare pay policies, number of IMGs

From the July/August 1997 ACP Observer, copyright 1997 by the American College of Physicians.

A new report on graduate medical education reform says that Congress and the Department of Health and Human Services must change Medicare payment policies to reduce the size of the physician workforce—and focus on cutting the number of international medical graduate (IMG) residents who remain in the United States to work.

The report, released last month by the Council on Graduate Medical Education (COGME), emphasizes that any changes in payment must continue to support primary care training "to ensure that the amount and quality of such training continues or increases." The report also says that the government should provide support to community hospitals that currently depend on physician residents to provide critical services.

COGME proposes cutting training slots—a goal supported by ACP—by revising Medicare graduate medical education payments and by gradually decreasing the number of IMGs, who have accounted for most of the increase in U.S. residents. In 1988, the report states, there were 11,556 IMG residents; in 1995, that number had grown to 26,783. Meanwhile, the total number of residents increased from 82,791 in 1988 to 104,612 in 1995.

ACP maintains that to better balance physician supply, the nation must reduce the total number of residency training slots and limit the supply of IMGs. The College also asserts, however, that the United States has a responsibility to provide training opportunities to outstanding physicians and scientists from throughout the world.

The COGME report also notes that many of the IMGs who train in the United States have remained in or returned to the country "to permanently add to the physician workforce." To reduce the number of IMG trainees, COGME is recommending that Congress modify the temporary visa exchange-visitor (J-1 visa) program to ensure that IMGs who train in the U.S. return to their home countries, as well as change the financial incentives to encourage hospitals to reduce their training activities.

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