Impact of the Resident Caps on the Supply of Geriatricians;Report to the Congress

摘要

The Balanced Budget Act of 1997 (BBA) placed a cap on the number of residents Medicare would support through its direct graduate medical education payment and indirect medical education (IME) adjustment. Before the BBA, Medicare payments increased with each additional resident a hospital trained. The resident cap was put in place to eliminate the incentive hospitals had to increase the number of residents they trained and thereby increase their payments. Some policymakers are concerned that the cap is constraining the supply of geriatricians, physicians who specialize in caring for the elderly. This paper responds to a request in MedPAC's 2001 appropriations report language to examine this issue. In brief, we find that the number of first-year geriatric fellowship positions continued to increase even after imposition of the cap, and that the number of physicians entering these programs has not kept pace with increases in the number of geriatric positions. Moreover, Medicare provides higher direct medical education rates for geriatric residencies. We conclude that no changes are necessary to Medicare's resident cap, as the persistent vacancies in geriatric programs indicate that other forces are responsible for the slow growth of this profession.