Department of Health Policy and Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
Robert Graham Center, Washington, District of Columbia.
JAMA Netw Open. 2021 May 3;4(5):e2111797. doi: 10.1001/jamanetworkopen.2021.11797.
Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.
To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted using data from 1252 US teaching hospitals. Data were analyzed from May through August 2020.
Dental and podiatry residency training.
Medicare dental and podiatry GME payments were examined.
Among 1252 teaching hospitals, Medicare provided nearly $730 million in dental and podiatry GME payments in 2018. From 1998 to 2018, the number of residents supported more than doubled, increasing from 2340 residents to 4856 residents, for a 2.1-fold increase, while Medicare payments for dental and podiatry GME increased from $279 950 531 to $729 277 090, for a 2.6-fold increase. In 2018, an estimated 3504 of 4856 supported positions (72.2%) were dental. Medicare GME payments varied widely among states, territories, and the District of Columbia, with per capita payments by state, territory, and district population ranging from $0.05 in Puerto Rico to $14.24 in New York, while 6 states received no support for dental or podiatry residency programs.
These findings suggest that dental and podiatry GME represents a substantial public investment, and deliberate policy decisions are needed to target this nearly $730 million and growing investment to address the nation's priority oral and podiatry health needs.
口腔保健面临持续的劳动力挑战，影响患者的可及性和治疗效果。虽然联邦医疗保险计划每年向教学医院提供约 146 亿美元的研究生医学教育（GME）拨款，其中包括对牙科和足病学项目的明确支持，但对于这项公共投资在口腔健康和足病学劳动力中的水平或分布情况，人们知之甚少。
本研究旨在调查从 1998 年到 2018 年，联邦医疗保险计划向教学医院支付给牙科和足病学住院医师培训的 GME 费用，以及在各州、领地和哥伦比亚特区之间分配的联邦支持情况。
设计、地点和参与者：本横断面研究使用了来自 1252 家美国教学医院的数据。数据于 2020 年 5 月至 8 月进行分析。
牙科和足病学住院医师培训。
调查了联邦医疗保险计划的牙科和足病学 GME 拨款。
在 1252 家教学医院中，联邦医疗保险计划在 2018 年提供了近 7.3 亿美元的牙科和足病学 GME 拨款。从 1998 年到 2018 年，接受培训的住院医师人数增加了一倍多，从 2340 人增加到 4856 人，增长了 2.1 倍，而牙科和足病学 GME 的联邦医疗保险计划支出从 27995.05 万美元增加到 72927.71 万美元，增长了 2.6 倍。2018 年，在 4856 个受支持的职位中（72.2%），估计有 3504 个是牙科职位。各州、领地和哥伦比亚特区之间的 GME 拨款差异很大，按州、领地和区人口计算，人均拨款从波多黎各的 0.05 美元到纽约的 14.24 美元不等，而有 6 个州没有为牙科或足病学住院医师项目提供任何支持。
这些发现表明，牙科和足病学 GME 代表了一项重大的公共投资，需要做出深思熟虑的政策决策，将这笔近 7.3 亿美元且不断增长的投资用于解决国家优先的口腔和足病健康需求。
