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Medicare and the Training of Surgeons
EDITORIAL
Medicare and the Training of Surgeons
M
any surgical educators appear to be confused or uncertain about the implications of Medicare legislation as it affects the training of surgeons. Some are alarmed. Dr. Frank Glenn" fears that the program will result in a deterioration of surgical training. Others, such as Dr. George Crile, Jr.,t think (rather prophetically, I believe) that Medicare has the potential of improving surgical training programs. Whatever opinions may be held, the fact of the matter is that Medicare has been implemented; I suggest that we adopt a positive attitude toward it and make it work to the betterment of surgical education. In our consideration of this problem we should realize that we need not tilt at windmills; according to Dr. Erwin Witkin, a spokesman for the Social Security Administration, the federal government is well aware of the need for operating experience by residents in training, does not wish to impair this experience, and will cooperate in any way that will not deprive the patient of the benefits to which he is entitled under the law. Solutions can certainly be worked out within this formula that will satisfy all concerned. In addition, the money made available under Part B of the program will go far toward meeting the clinical and research expenses of surgical departments and allow expansion of their teaching facilities. For the patients who do not subscribe to Part B, there are no medical fees involved, so that the approach to teaching as practiced in the past will not be affected. There will be benefits which accrue to teaching programs, since the hospitals will be partially relieved of their burden of subsidizing free beds for teaching purposes and might logically be expected to provide more such beds. Mostly, however, we are concerned with those patients who pay into the indemnity plan, or Part B, since they comprise 17.6 million of the 19 million persons covered by Medicare. They are paying for, and are entitled to, private patient *Glenn, F. Medicare and surgical residency programs. Surg. Gynec. Obstet. 122: 1317, 1966. tCrile, G., Jr. Another way to look at Medicare and surgical residency programs. Surg. Gynec. Obstet. 123:834, 1966.
386
THE ANNALS OF THORACIC SURGERY
Editorial
status. It is true that many of these patients will seek care in nonteaching hospitals, as private patients have always done, but large numbers will seek care in teaching institutions in the belief that in this atmosphere they will receive the best that medicine has to offer. Generally these patients consider the hospital or clinic rather than the individual surgeon. It is not difficult to indoctrinate such patients in the team concept of surgical care. Since the chief of service or his designates will see these patients on rounds and will, or should, be available for immediate consultation or assistance during operations performed by the resident, he will have performed a recognizable service and is entitled to a surgical fee. While our concept of the senior year of surgical training implies that the resident shall accept complete responsibility for the patient, this is never strictly the case since in the final analysis, the chief of service is responsible for the conduct of all individuals in his department and for the care of all patients on his service. It is therefore difficult to see how Medicare, if properly approached, will impair the quality of surgical training; it may, since there is more money in the atmosphere generated through surgical fees, enable surgical services to enhance their educational programs. F. X. BYRON,M.D.
NOTICE FROM THE BOARD O F THORACIC SURGERY T h e 1968 spring examinations will be given as follows: Written Examination. T o be held at various centers throughout the country on February 8, 1968. Final date for filing applications is December 1, 1967. Oral Examination. T o be given in April, 1968 in Pittsburgh, Pa.; final date for filing applications is December 1, 1967. Please address all communications to the Board of Thoracic Surgery, Inc., 1151 Taylor Ave., Detroit, Mich. 48202.
VOL.
4,
NO.
4,
OCT.,
1967
387
Medicare and the Training of Surgeons
M
any surgical educators appear to be confused or uncertain about the implications of Medicare legislation as it affects the training of surgeons. Some are alarmed. Dr. Frank Glenn" fears that the program will result in a deterioration of surgical training. Others, such as Dr. George Crile, Jr.,t think (rather prophetically, I believe) that Medicare has the potential of improving surgical training programs. Whatever opinions may be held, the fact of the matter is that Medicare has been implemented; I suggest that we adopt a positive attitude toward it and make it work to the betterment of surgical education. In our consideration of this problem we should realize that we need not tilt at windmills; according to Dr. Erwin Witkin, a spokesman for the Social Security Administration, the federal government is well aware of the need for operating experience by residents in training, does not wish to impair this experience, and will cooperate in any way that will not deprive the patient of the benefits to which he is entitled under the law. Solutions can certainly be worked out within this formula that will satisfy all concerned. In addition, the money made available under Part B of the program will go far toward meeting the clinical and research expenses of surgical departments and allow expansion of their teaching facilities. For the patients who do not subscribe to Part B, there are no medical fees involved, so that the approach to teaching as practiced in the past will not be affected. There will be benefits which accrue to teaching programs, since the hospitals will be partially relieved of their burden of subsidizing free beds for teaching purposes and might logically be expected to provide more such beds. Mostly, however, we are concerned with those patients who pay into the indemnity plan, or Part B, since they comprise 17.6 million of the 19 million persons covered by Medicare. They are paying for, and are entitled to, private patient *Glenn, F. Medicare and surgical residency programs. Surg. Gynec. Obstet. 122: 1317, 1966. tCrile, G., Jr. Another way to look at Medicare and surgical residency programs. Surg. Gynec. Obstet. 123:834, 1966.
386
THE ANNALS OF THORACIC SURGERY
Editorial
status. It is true that many of these patients will seek care in nonteaching hospitals, as private patients have always done, but large numbers will seek care in teaching institutions in the belief that in this atmosphere they will receive the best that medicine has to offer. Generally these patients consider the hospital or clinic rather than the individual surgeon. It is not difficult to indoctrinate such patients in the team concept of surgical care. Since the chief of service or his designates will see these patients on rounds and will, or should, be available for immediate consultation or assistance during operations performed by the resident, he will have performed a recognizable service and is entitled to a surgical fee. While our concept of the senior year of surgical training implies that the resident shall accept complete responsibility for the patient, this is never strictly the case since in the final analysis, the chief of service is responsible for the conduct of all individuals in his department and for the care of all patients on his service. It is therefore difficult to see how Medicare, if properly approached, will impair the quality of surgical training; it may, since there is more money in the atmosphere generated through surgical fees, enable surgical services to enhance their educational programs. F. X. BYRON,M.D.
NOTICE FROM THE BOARD O F THORACIC SURGERY T h e 1968 spring examinations will be given as follows: Written Examination. T o be held at various centers throughout the country on February 8, 1968. Final date for filing applications is December 1, 1967. Oral Examination. T o be given in April, 1968 in Pittsburgh, Pa.; final date for filing applications is December 1, 1967. Please address all communications to the Board of Thoracic Surgery, Inc., 1151 Taylor Ave., Detroit, Mich. 48202.
VOL.
4,
NO.
4,
OCT.,
1967
387