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OCR for page R1
PRIMARY CARE PHYSICIANS: FINANCING
THEIR GRADUATE MEDICAL EDUCATION
IN AMBULATORY SETTINGS
A Report of a Study by a Committee of the
Institute of Medicine
Division of Health Care Services
National Academy Press
Washington, D.C. 1989
OCR for page R2
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn
from the councils of the National Academy of Sciences, the National Academy of
Engineering, and the Institute of Medicine. The members of the committee
responsible for the report were chosen for their special competencies and with
regard for appropriate balance.
This report has been renewed by a group other than the authors according to
procedures approved by a Report Review Committee consisting of members of the
National Academy of Sciences, the National Academy of Engineering, and the
Institute of Medicine.
The Institute of Medicine was- chartered
Sciences to enlist distinguished members
examination of policy matters nerta~n~n~
Institute acts under both the Academy's
. . . ~
in 1970 by the National Academy of
of the appropriate professions in the
to the health of the public. In this, the
1863 congressional charter responsibility
to be an advisor to the federal government and its own initiative in identifying
issues of medical care, research, and education.
This project received support from the Josiah Macy, dr. Foundation (Grant
#BS92003) and the Health Resources and Services Administration, Department of
Health and Human Services (Order Numbers 89-287 (P) and 89-288 (P)~.
2101 Constitution Avenue, N.W
Washington, D.C. 20418
(202) 33~3300
Library of Congress Catalog Card No. 89-639~34
International Standard Book Number 0-309-0413~!
Additional copies of this report are available from:
National Academy Press
2101 Constitution Avenue, NW
Washingcon, DC 20418
S051
Printed in the United States of America
IOM 89-10
F=t Printing, December 1989
Second Printing, Navanber 1990
.
OCR for page R3
INSTITUTE OF MEDICINE
COMMITTEE TO STUDY STRATEGIES FOR SUPPORTING GRADUATE MEDICAL
EDUCATION FOR PRIMARY CARE PHYSICIANS IN
AMBULATORY SETTINGS
DANIEL D. FEDERMAN,* (Chairman), Dean for Students and Alumni,
Professor of Medicine, Harvard Medical School, Boston,
Massachusetts.
EXALTON A. DELCO, dR., Vice President for Academic Affairs,
Austin Community College, Austin, Texas.
HENRY W. FOSTER, dR.,* Professor and Chairman, Department of
Obstetrics and Gynecology, Diehard Medical College,
Nashville, Tennessee.
JOHN P. GEYMAN,* Professor and Chairman, Department of Family
Medicine, University of Washington, Seattle, Washington,
RUTH T. GROSS,* Professor of Pediatrics, Stanford Universitr,
Stanford, California.
RUTH S. HANFT,* Research Professor and Health Policy Consultant,
Department of Health Services Administration G,`~or~r~ Wn~Lin~t~n
University, Washington, D.C.
~_ ~ ~ _ ~ ~ ~O vent
DAVID A. KINDIG, Professor of Preventive Medicine, Director of
Administrative Medicine and Health Services, University of
Wisconsin, Madison, Wisconsin.
SHELDON S. KING,* President and Chief Executive Officer, Cedars-Sinai Medical
Center, Los Angeles, California.
GORDON T. MOORE, Director of Teaching Programs, Harvard Community
Health Plan, Boston, Massachusetts.
· · -
OCR for page R4
WILBUR B. PITTINGER, Chief Operating Officer, Department of
Internal Medicine, University of Michigan Medical Center,
Ann Arbor, Michigan.
RICHARD E. RIESELBACH, Associate Dean, University of Wisconsin
Medical School, Milwaukee, Wisconsin.
NEAL A VANSELOW,* Chancellor, Tulane University Medical Center,
New OrIeans, Louisiana.
MICHAEL ZUBKOFF,* Professor and Chairman, Department of Community
and Family Medicine, Dartmouth Medical School, Hanover, New
Hampshire.
INSTITUTE OF MEDICINE STAFF
JESSICA TOWNSEND, Study Director
KARL D. YORDY, Director, Division of Health Care Services
DEE SUTTON, Senior Secretary
WALLACE WATERFALL, Editor
* Member, Institute of Medicine
-~v
OCR for page R5
CONTENTS
SUMMARY
INTRODUCTION
Scope of the Study
Conduct of the Study
....... 10
~ e ~ ~ ~ e ~ e ~12
CHAPTER 1. CONCERNS ABOUT PRIMARY CARE RESIDENCY
TRAdNING 15
New Directions for Primary Care
Residencies
Other Policy Issues Relating to Financing
Primacy Care GME . . . . . . . . . . . .
CHAPTER 2. COSTS AND REVENUES FOR PRIMARY CARE
RESIDENCIES IN AMBULATORY SETTINGS
Introduction
Costs
Revenues
CHAPTER 3. OPTIONS AND RECOMMENDATIONS
Barriers
Criteria for Evaluating Policy Options
Conclusions and Recommendations . . .
APPENDIX A. Workshop Program and Proceedings
-v-
20
35
35
35
38
52
53
56
65
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APPENDIX B.
The Cost of Graduate Medical Education in
Outpatient Settings. Judith R. Lave . . . .
Financing of Medical and Graduate Medical
Education: Issues in Primary Care Education
Support. Ruth S. Hanft . . . .
Financing Graduate Medical Education in Primary
Care: Options for Change. Sandra C. Peinado
and John M. Eisenberg
Financing Primary Care Residency Training:
Examples and Lessons from Successful Programs
Robert A. Walkington
.
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.... 144
.. 173
197
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