Grand poobahs, long robes, ivory palaces, exulted wise men — is it the Arabian Nights? — no, it’s graduate medical education in the US. Finally, a voice of reason — coming from the Institute of Medicine (IOM). The surprising report released 7/29/14 says doctor training is not meeting the needs of the country.
The problems: $18 billion per year going to academic medical centers without adequate accountability. Money lavished on the Northeast fails to trickle down to community training programs elsewhere. Self-serving training of an academic workforce but not main-street primary care.
The US has never had a coherent plan to train doctors — academic medical centers have been making decisions that should have been made by ordinary people, people who don’t like waiting lists. A huge manpower shortfall has been expected for a long time. The IOM expert committee is calling for big changes to the system. The hope of the country, West of Harvard, is that Congress will follow the recommendations — the report is not asking for more money (which would be a stake in the heart) just a rational use of funds to meet obvious needs.
A primary care doctor does not need to go to Harvard to be a very good doctor and the US does not need to support super specialty programs at the expense of towns lacking a doctor. The cost savings by diverting funds to community training programs could be huge, possibly training 2 or 3 physicians instead of one in Boston.
Funding of training needs to be tied to providing service where service is needed. What better way to train doctors for Iowa (or other areas needing doctors) — train young people in the communities where they live.