As a result, Medicare GME funds are spread among all HMO contractors, without being focused on those that actually have teaching programs or necessarily use teaching hospitals for services. E. Support Public Health Service Act Title VII education programs, which have ultimate underserved practice as a goal. Efforts need to be strengthened to encourage the domestic production of competent generalists who will serve in these areas. Most Title VII physician education programs operate under a statutory funding preference for applicants who demonstrate success in placing graduates in underserved communities. If Medicare GME payment caps are enacted, there should still be opportunities for Medicare DME and IME payments to encourage primary care residency programs in areas where relatively few or no programs exist.
Residents frequently remain near the hospital where they received their residency training.
The competency of primary care practitioners is dependent upon training in the proper settings such as in ambulatory sites in community-based hospitals. Promotion of new primary care residency programs can provide this type of training to physicians. These primary care physicians can offset the adverse impact of residency reduction and changes in the health service delivery environment by providing continuing, longitudinal, comprehensive general care to Medicare beneficiaries and vulnerable populations. Such a freeze has historical precedent. This differential should be examined periodically for effectiveness.