title: The Projected Responses of Residency-Sponsoring Institutions to a Reduction in Medicare Support for Graduate Medical Education: A National Survey.
abstract: OBJECTIVE
  To assess the projected responses of residency-sponsoring institutions to the proposed reduction in Medicare's indirect medical education (IME) payments.
  
  
  METHODS
  In 2012, the authors surveyed directors of graduate medical education (GME) programs, examining (1) overall responses to a reduction in IME reimbursement and (2) the value of individual residencies to the institution from the economic/operational and educational/public service points of view, to determine which programs may be at risk for downsizing.
  
  
  RESULTS
  Responses from 192 of 555 institutions (35% response rate) varied by the size of the institution's GME program. Of large programs (six or more residencies), 33 (33%) would downsize at a 10% reduction in IME reimbursement, focusing cuts on specific programs. Small programs (five or fewer residencies) were more likely to retain their existing residencies with modest IME payment reductions and to make across-the-board cuts. The economic/operational value of specialties varied widely, with hospital-intensive residencies valued highest. Family medicine was valued highly from an economic/operational point of view only by small programs. Educational/public service value scores varied less and were higher for all specialties. Preventive medicine was not highly valued in either category.
  
  
  CONCLUSIONS
  Even a modest decrease in IME reimbursement could trigger institutions to downsize their GME programs. Programs at the greatest risk for cuts may be those with modest economic/operational value but high societal value, like family medicine. The retention or expansion of training in family medicine may be most easily accomplished then at smaller institutions.
authors.affiliation: M. Riaz is a graduate, Program in Public Health, Stony Brook University, Stony Brook, New York, and research assistant, Mailman School of Public Health, Columbia University, New York, New York.T. Palermo is a core member, Program in Public Health, and assistant professor of preventive medicine, Stony Brook University, Stony Brook, New York.M. Yen is a graduate, Program in Public Health, Stony Brook University, Stony Brook, New York, and research assistant, Monter Cancer Center, North Shore-Long Island Jewish Health System, Lake Success, New York.N.H. Edelman is a core member, Program in Public Health, and professor of preventive and internal medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Mahrukh
authors.initials: M
authors.lastname: Riaz
authors.forename: Tia
authors.initials: T
authors.lastname: Palermo
authors.forename: Michael
authors.initials: M
authors.lastname: Yen
authors.forename: Norman H
authors.initials: NH
authors.lastname: Edelman
mesh_terms: D004503:Education, Medical, Graduate / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D006278:Medicare / Q000191:economics*; D020415:Personnel Downsizing; D011795:Surveys and Questionnaires; D014146:Training Support / Q000191:economics*; D014481:United States