Reimbursing for residency training: how many times?

Through an investigation of charges generated for 105 patients treated for congestive heart failure, three issues of reimbursement policy for graduate medical education are examined: 1) reimbursement policy by third parties for resident salaries and for the portion of teaching physicians' time devoted to graduate medical education; 2) the level of involvement for physicians in dual roles as attending physicians for private patients when simultaneously engaged in graduate medical education and supervising patient care delivered by residents; and 3) the greater utilization of hospital resources in teaching units. The results demonstrate that the reimbursement policy, as presently practiced, ignores the basic differences in the level of involvement between teaching and nonteaching physicians. The data also show for the first time the incremental effect of graduate medical education in a teaching hospital. Several alternatives are suggested to eliminate the deficiencies.