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As HMOs shift patients away from long stays at hospitals and shrink reimbursements for services, Anderson and Haynes are seeing not only their patients but their revenues trickle away. Anderson estimates that the faculty makes 25% less money now for the same amount of work than it did several years ago. That devaluation carries over to the residents; unlike medical students, the 800 residents at Duke are paid, up to $40,000 a year. It costs Duke an additional $100,000 a year to train each one. Traditionally the funding for residents has come from faculty members, who contribute 20% of their earnings in the clinics to support education efforts, and from subsidies by the Federal Government through Medicare.
The current Medicare-reform bill being debated in Congress, however, proposes abolishing this subsidy because other insurers are not obligated to support medical education. Duke's government-relations representative, Paul Vick, is hoping to impress upon Congress the importance of a fiscally sound hospital with a steady flow of patients running a good residency program. "You can't just build four square walls and put in a faculty," says Vick.
Anderson and Haynes are bracing for what could be an even leaner future. Already they have begun to spend more time at their least-favorite activity: fund raising. Their other, even more painful, option is to train fewer doctors. The triage has already started. "With the advent of angioplasty and better medications, for example, we did not feel that the world needed more cardiothoracic surgeons," says Anderson. So Duke now admits three new cardiac-surgery residents each year instead of four.
Will such measures be enough? As revenues shrink, the department heads are forced to dip deeper into the coffers. "At some point," says Anderson, "we will have to say we do not have enough funding to educate this many residents, and we may have to cut back more."
--By Alice Park