Primary Care Physicians: Financing Their Graduate Medical Education In Ambulatory Settings -- Copyright -- Contents -- Summary -- PROBLEMS IN FINANCING GME FOR PRIMARY CARE PHYSICIANS IN AMBULATORY SETTINGS -- ADDITIONAL BENEFITS FROM IMPROVING SUPPORT FOR PRIMARY CARE GME -- COMMITTEE CONCLUSIONS AND RECOMMENDATIONS -- Physician Payment Reform -- Medicare Direct Graduate Medical Education Payment -- Medicare Indirect Graduate Medical Education Adjustment -- State and Local Roles -- Grants -- Academic Leadership -- Efficient Use of Training Resources -- Introduction -- SCOPE OF THE STUDY -- CONDUCT OF THE STUDY -- REFERENCES -- Chapter 1 Concerns about Primary Care Residency Training -- NEW DIRECTIONS FOR PRIMARY CARE RESIDENCIES -- Why is There a Need to Increase Ambulatory GME? -- The Match Between Training and Practice Sites -- Primary Care Physicians and Cost Containment -- OTHER POLICY ISSUES RELATING TO FINANCING PRIMARY CARE GME -- REFERENCES -- Chapter 2 Costs and Revenues for Primary Care Residencies in Ambulatory Settings -- INTRODUCTION -- COSTS -- REVENUES -- Federal Manpower Policy and GME for Primary Care -- State Support for GME -- The Veterans Administration -- Patient Care Support -- REFERENCES -- Chapter 3 Options and Recommendations for Financing Graduate Medical Education for Primary Care Physicians in Ambulatory… -- BARRIERS -- Costs of Training -- The Reimbursement Playing Field is Not Level -- Academic Barriers -- CRITERIA FOR EVALUATING POLICY OPTIONS -- Budget Constraints -- Matching the Needs of Primary Care Residency Programs -- Do No Harm to Valued Institutions and Activities -- Administration -- CONCLUSIONS AND RECOMMENDATIONS -- Academic Leadership -- Efficient Use of Training Resources -- Physician Payment Reform -- Medicare Direct Graduate Medical Education Payment.

Medicare Indirect Graduate Medical Education Adjustment -- State and Local Roles -- Grants -- REFERENCES -- Appendix A Program and Proceedings of a Workshop -- PROGRAM -- APRIL 18, 1989 -- INTRODUCTION -- CHARACTERISTICS OF PRIMARY CARE GRADUATE MEDICAL EDUCATION IN THE AMBULATORY CARE SETTING -- Demographics of Pediatric Training and Practice -- The Setting of Residency Training -- Medical Education as an Apprenticeship Model -- The Residency Review Committee -- Challenges of Primary Care Education -- Funding Constraints -- Bibliography -- GRADUATE EDUCATION IN FAMILY MEDICINE - ITS AMBULATORY EMPHASIS -- Bibliography -- THE CASE FOR INCREASING THE EDUCATION OF GENERAL INTERNISTS IN AMBULATORY SETTINGS -- CHARACTERISTICS OF PRIMARY CARE OSTEOPATHIC GRADUATE MEDICAL EDUCATION IN THE AMBULATORY SETTING -- Overview -- The Michigan State University College of Osteopathic Medicine -- Model4 -- The Kirksville College of Osteopathic Medicine Model -- Summary -- References -- Discussion -- COST AND REVENUES FOR GRADUATE MEDICAL EDUCATION -- Introduction -- History of Support -- Patient Care Support -- Role of the States -- Primary Care Residencies and Ambulatory Care Training -- Who Should Support GME? -- THE COST OF GRADUATE MEDICAL EDUCATION IN OUTPATIENT SETTINGS -- Discussion -- LESSONS FROM THE EXPERIENCES OF PROGRAM DIRECTORS -- Introduction -- Lesson One -- Lesson Two -- Lesson Three -- Lesson Four -- Data Management is Essential in Primary Care Training, not a Luxury -- Conclusion -- References -- LESSONS FROM A PEDIATRIC PROGRAM DIRECTOR -- PRIMARY CARE PROGRAMS: THEN (1980) AND NOW (1990) -- 1980 -- 1990 -- Discussion -- The Allocation Of Resources At The Institutional Level -- The Problem -- POLICY OPTIONS -- Discussion -- Appendix B -- THE COST OF GRADUATE MEDICAL EDUCATION IN OUTPATIENT SETTINGS -- Introduction.

The Cost of Medical Training in Hospitals -- Cost of Training in The Outpatient Sector: An Analytical Approach -- Empirical Studies of The "Net Cost" of Training In The Outpatient Setting -- Time and Motion Studies -- Replacement Cost Studies -- Before and After Studies -- Comparative Cost Studies -- Differences in the Use of Ancillary Services -- Summary -- What Is The Financial Impact Of Training Programs In Primary Care? -- Net Revenues from a Program in Primary Practice -- Programs in Family Practice -- General Internal Medicine Ambulatory Practices in Teaching Hospitals -- Summary -- Discussion: Other Issues -- The Efficiency of the Training Process -- The Patient's Role -- The Efficiency with Which the Practice is Operated -- Training in the Health Maintenance Organization -- Conclusions -- Bibliograpy -- FINANCING OF MEDICAL AND GRADUATE MEDICAL EDUCATION EDUCATION: ISSUES IN PRIMARY CARE EDUCATION SUPPORT -- Introduction -- History of Support -- Federal Support -- Biomedical Research -- Education Support -- Patient Care Support -- Role of the States -- Primary Care Residencies and Ambulatory Care Training -- The Importance of Patient Payor Mix As A Source of Financing of Primary Care Education -- Who Should Support GME -- References -- FINANCING GRADUATE MEDICAL EDUCATION IN PRIMARY CARE: OPTIONS FOR CHANGE -- Abstract -- Current GME Financing -- Payment for Patient Care -- Direct Federal Support -- Direct State Support -- Issues For Primary Care GME Raised By Current Funding Scheme -- Resident Compensation -- Faculty compensation -- General Concerns -- Criteria For Evaluating Alternative Proposals -- Financial Criteria -- Administrative Criteria -- Educational Criteria -- Stakeholders' Criteria -- Source of Funds -- Change in Existing Medicare GME Payments -- Increase in Categorical GME Funding -- Increase in Ambulatory Payment.

Grant Support -- Commitment from Future Employer -- Redistribution of Funds -- Expenditure Alternatives -- Analysis of Funding Options -- Analysis of Spending Alternatives -- Summary -- RECOMMENDATIONS FOR FURTHER ANALYSIS -- Acknowledgments -- References -- FINANCING PRIMARY CARE RESIDENCY TRAINING EXAMPLES AND LESSONS FROM SUCCESSFUL PROGRAMS -- Introduction -- Problems With Current Financing of Ambulatory Primary Care Education -- Published Examples of Successful Financing of Ambulatory Based GME -- Other Examples of Successful Financing -- Summary -- References -- Exhibit 1.