Introduction
The headline for the Boston Globe article on September 5th,
2000 read “Applications to U.S. Medical Schools Drop Again.”[i] The article went on to
report that applications to U.S. medical schools fell 3.7% in the year 2000, representing the fourth straight year of decline
in the number of applicants. Does the headline qualify as good news or bad news? Apparently, like most health care issues, the answer depends on the perspective of
those you are asking.
Despite the drop in applicants
numbers, however, the article goes on to disclose the fact that there are still more than twice
the number of applicants as there are places (i.e., residency ‘slots’)
for them. More curious than these figures suggest, however, is the fact that at
least one study has found that fewer than ten percent (10%) of U.S.
medical school graduates in their first year of pediatric or internal medicine residency programs could adequately perform
13 basic clinical exam procedures correctly. More than half of the foreign-born
residents being trained at U.S. medical
schools, however, were able to perform all of the procedures accurately.[ii] Examples such as
these beg the question: Are we [who support the costs of graduate medical education training] getting our ‘money’s
worth?’
The issue of financing graduate medical education [GME] is a
complicated one, made even more so by the array of ‘stakeholders’ who maintain strong opinions about what is wrong
with the current [financing] system, and what the best avenues for improving it are.
This paper will present the foundation upon which GME financing evolved over the years, and will describe some of the
on-going recommendations for ‘curing’ the system of its ills. It
may be helpful to first define some of the basic components and players in the GME drama....
[i] Associated Press,“Applications to U.S.
Medical Schools Drop Again,” The Boston Globe, 9/5/01, p. A7.
