The federal government and the future of US medical training
Residency is a mandatory step to achieving medical licensure in the US. Most residency programs are managed by hospitals, although my medical school is one of the ca. 10% that manages its own residency programs.
The federal government, primarily through Medicare and Medicaid, is the largest source of funding for Graduate Medical Education (GME), which includes residency programs. Residency training is a significant bottleneck in the pathway for new physicians. If DOGE elected to cut off federal funding for GME, it would strangle medicine in the US unless (a) residency training was eliminated as a licensure requirement and/or (b) GME training were handed off to private equity firms that are already buying up hospitals across the country. I don’t see how either of these options improves healthcare for Americans.
The federal government, primarily through Medicare and Medicaid, is the largest source of funding for Graduate Medical Education (GME), which includes residency programs. Residency training is a significant bottleneck in the pathway for new physicians. If DOGE elected to cut off federal funding for GME, it would strangle medicine in the US unless (a) residency training was eliminated as a licensure requirement and/or (b) GME training were handed off to private equity firms that are already buying up hospitals across the country. I don’t see how either of these options improves healthcare for Americans.
Kaiser Permanente started their own medical school in 2020. It is accredited, and the students have lots of opportunity for clinical experience in the Kaiser facilities. I think of it as grow-your-own doctors or vertical integration for medicine. Students enrolling from 2020-2025 will have their tuition waived. They are actively seeking members of “underserved” communities, the dreaded DEI. One version of fighting the doctor shortage.
@Jane,
Interesting. However, residents are not medical students. All residents have completed the MD/DO degree before they start their residency.
According to their curriculum the last 2 years of study include clinical experiences. Observation or practice? hard to say. There are a lot of ways students could learn just by assisting a physician. I imagine Kaiser will offer some of the graduates residency in their hospitals as well.
@Jane,
I can’t think of an American medical school that hasn’t always had the last two years with clinical clerkships. Certainly, that was true at my medical school for the entire 37 years I was on faculty (and is still true since I retired). Indeed, many medical schools, including ours, have recently started clinical clerkships during the second year, to allow more clinical experiences before students have to apply for residency. UVa has only the first year pre-clinical and the remaining 3 years are all clinical, a model that other US medical schools are adopting. But medical school clerkships are not residencies, which was the topic of my post.
I don’t believe medical students are allowed to practice unsupervised. Indeed, I don’t think there are any states that license MD grads without at least a year of residency.
I’m sure Kaiser will recruit residents from their MD graduates. We do the same. They may even have better luck with their own trainees because CA is so expensive and so resident candidates from other states may be harder to recruit.