Impact of Managed Care on Internal Medicine Graduate Medical Education at Brooke Army Medical Center.

摘要

Brooke Army Medical Center (BAMC) is a 450-bed tertiary care hospital with a multi-fold mission to provide comprehensive patient care, medical education, and research. The implementation of managed care has caused BAMC's focus to shift from an academic role to a primary care role, with increased emphasis on productivity and cost-effectiveness. Successfully balancing managed care programs and graduate medical education (GME) programs has been especially challenging because managed care goals are often inconsistent with the traditional goals of a specialty driven, academic teaching institution. This project studied data on BAMC's Internal Medicine Residency Program (1993 - 1999) to identify changes attributable to implementation of managed care. Results showed both positive and negative impacts. It has increased the staff's focus on prevention and on their responsibility to provide a continuum of care to enrolled beneficiaries. This has had a positive influence on the procedure workload for internal medicine because it is a primary care service. However, research and workload data indicate that the environment for training and education is becoming more constrained.