Prout D M
J Gen Intern Med. 1986 Jan-Feb;1(1):44-8. doi: 10.1007/BF02596325.
Since 1976, federal support for training in general internal medicine has been provided through the primary care residency programs under Title VII of the Public Health Service Act. Continuation of these programs is now in jeopardy because of severe fiscal pressures and the response of Congress to the resulting budgetary stringency. General internal medicine faces immediate problems in the budgetary, authorization, and appropriations arenas. However, Congressional proposals for changing the method by which Medicare pays for all graduate medical education may provide an important opportunity. Under a revised method of financing graduate medical education, general internal medicine could eliminate its historical dependence on increasingly unstable federal grant funds and could contribute to the development of new federal incentives for training in the primary care specialties.
自1976年以来，联邦政府一直通过《公共卫生服务法》第七章下的初级保健住院医师培训项目，为普通内科培训提供支持。由于严峻的财政压力以及国会对由此产生的预算紧缩的反应，这些项目的延续目前面临危机。普通内科在预算、授权和拨款领域面临紧迫问题。然而，国会关于改变医疗保险支付所有毕业后医学教育方式的提议可能提供一个重要机遇。在修订后的毕业后医学教育融资方法下，普通内科可以消除其历来对日益不稳定的联邦拨款资金的依赖，并可为制定新的联邦初级保健专科培训激励措施做出贡献。
