TAMPA — One part of the national debt debate has medical schools in rapt attention.
If the final deal cuts Medicare funding as much as some have said it might, partially by targeting graduate medical education, college folks say Florida could move even more quickly toward becoming an "exporter of doctors" — a track some say the state is already on.
The reason is this: Florida's teaching hospitals don't have enough residency slots for the hundreds of medical students who graduate each year. Any cut to Medicare, which largely funds those training programs, could exacerbate the problem.
The exact amount that might be cut from graduate training programs — as part of budget-balancing negotiations tied to an Aug. 2 deadline to raise the government's debt ceiling — is still up in the air. Estimates range from 20 to 60 percent of Medicare's $9 billion annual payout to teaching hospitals.
But medical education leaders say a cut of any size would have drastic effects.
"I think Congress really ought to think about where they want to perform the cuts … and I won't say the decision is easy," said Dr. Chuck Paidas, associate dean for the University of South Florida's graduate medical education. "But graduate medical education should not, underline, should not be one of them. They have the potential to dismantle a superb educational machine in quality health care."
Paidas' sentiment is echoed across the country, with med school deans writing editorials in newspapers and medical education groups unleashing lobbyists to Capitol Hill.
"I think that right now we are absolutely in crisis mode," said Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges. "We're devoting a significant amount of time to preserving what we have because that's still very much at risk."
Plus, Mitchell said, the teaching hospitals that host the slots typically provide more specialized care through trauma centers, burn units or pediatric divisions. They often care for sicker patients, with transfers regularly coming from less-equipped hospitals.
"Perhaps they (Congress) could reconsider options that could be spread more equitably across all the hospitals of the nation," Mitchell said. "Right now, we're just being railroaded into this enormous cut."
This story begins in 1997, when another budget negotiation froze residency slots at that year's numbers.
As time went on, many states' populations, including Florida's, went up. To fill a need for doctors, the state opened medical schools at Florida State University, the University of Central Florida and Florida International University.
Still, with no new residency slots for almost 15 years now, many of Florida's doctors have to train in other states. And studies show that young doctors typically settle down where they complete that training.
Last year, 867 medical students who graduated from Florida schools competed for 651 residency positions. The rest left.
"It's a major hole in the doughnut," said Frank Brogan, chancellor of the Florida Board of Governors, which oversees the state's 11 public universities.
Even before the debt debate recently heated up, Brogan visited Washington, D.C., to talk to members of Congress about the residency issue. He floated an idea for a match program, where the federal government could potentially match residency investments already being made by state schools or teaching hospitals.
He talked to legislators about the "800-pound gorilla" in the room — the Health Care Reform Act, which will soon bring millions more patients into the health care system. If the reforms are intended to stop people from relying on hospital emergency rooms for primary care, shouldn't the government make sure future doctors have a place to train?
"Starting the health-care reform legislation without this issue was like building the house without the roof first," Brogan said in an interview. "You're taking people out of the hospital and putting them right back in."
Though primary care is the place where experts typically point to a doctor shortage, USF's Paidas says there's a need for more doctors in every specialty. And the need will only become greater with future population growth and health care reform.
"We need more doctors," he said. "You really don't want to take a step backward with that."
And if Florida does take a step back?
"We will become, if we're not already, an exporter of doctors," Paidas said.
Reach Kim Wilmath at firstname.lastname@example.org or (813) 226-3337.