World & Politics5/10
Doctor Criticizes Hospitalist Model and Medicare Residency Funding
Anish Koka, MD, argues that the U.S. needs outpatient doctors and says Medicare-funded residency programs have produced hospitalists while displacing family physicians. He ties the issue to foreign graduate pipelines and medical school admission policy.
Original post · 1 min read
Apologies to hospitalists. Many do amazing things, work hard etc.
My point is that the acute need for patients now and as long as I can remember in America is doctors who will see outpatients 5 days of the week.
And yet the taxpayer has been paying for residency programs that are hospitalist factories.
So in the last 30 years “ progress “ is creating a whole separate class of doctors that see inpatients only. In order to make way for the hospitalists, the prior group that was doing this work (your family practice doctor) had to be displaced (at times forcibly).
The non profit hospital then turns around and complains about the rising cost of care and sends you a $10,000 bill for your one night stay.
And at the end of the day, the end result is a pipeline built for Aga Khan University students to come to America and make a top 1% American income with zero medical debt. This is in the context of 2/3 American applicants being rejected from medical school. Cherry on top is affirmative action policies that make the bar for white / Asian U.S. citizens to get into medical school very high.
So circling back to where this all started : do I think there are lots of qualified American citizens that could do the job trainees at these small programs are doing? 100% yes.
The current state of affairs is a policy choice that works against American citizens, not for American citizens. And American tax payer dollars fund all of it.
My point is that the acute need for patients now and as long as I can remember in America is doctors who will see outpatients 5 days of the week.
And yet the taxpayer has been paying for residency programs that are hospitalist factories.
So in the last 30 years “ progress “ is creating a whole separate class of doctors that see inpatients only. In order to make way for the hospitalists, the prior group that was doing this work (your family practice doctor) had to be displaced (at times forcibly).
The non profit hospital then turns around and complains about the rising cost of care and sends you a $10,000 bill for your one night stay.
And at the end of the day, the end result is a pipeline built for Aga Khan University students to come to America and make a top 1% American income with zero medical debt. This is in the context of 2/3 American applicants being rejected from medical school. Cherry on top is affirmative action policies that make the bar for white / Asian U.S. citizens to get into medical school very high.
So circling back to where this all started : do I think there are lots of qualified American citizens that could do the job trainees at these small programs are doing? 100% yes.
The current state of affairs is a policy choice that works against American citizens, not for American citizens. And American tax payer dollars fund all of it.
Anish Koka, MD @anish_kokaThere’s no guild interest in importing foreign labor.
This is a function of Medicare funding residency training spots.. lots of hospitals get paid to have a very cheap labor pool so they create these “training programs”
If you ended Medicare GME funding, a lot of these programs that primarily serve as an entry point to the U.S. market for developing labor would disappear.
The vast majority of these programs produce hospitalists — an invented “specialty “ that came into being to shorten length of hospital stays.
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