1. LSU Surgical Caucus AMA Interim Meeting New Orleans, LA November 14, 2011 Challenges Facing Academic Surgical Education in the Post-Health Reform Era.... OR.... * Bob Wachter – Assoc Chair, Dept Medicine, UCSF Are Academic Medical Centers Toast in a Post-Healthcare Reform World ?*

2. Peter W Carmel, MD, D Med Sci Professor and Chairman Department of Neurological Surgery The New Jersey Medical School Newark, New Jersey President

3. The New Jersey Medical School Honorary Alumnus!

4. For a copy of the slides – email to: carmel@umdnj.edu

5. Challenges Facing Surgical Education in the Post-Health Reform Era Manpower Financial Support (Who pays?) Length of Training/ Work-hours Restrictions Simulation Scope of Practice

6. Manpower

7. y = x 1.159 490,000,000 314,000,000 Almost 60 % Your career

8. Workforce Issues Projected Physician Shortage

9. Entering US Medical School Class 2011 Largest entering class in US history – 18,665 Up by 15.5% from 2003 More than 42,740 applicants, (stable over 3 years), of which almost 32,000 were first-time applicants, also a record (up 2.5% from 2010) Eleven of 126 medical schools increased enrollment by over 10 % from 2006 Survey indicates that schools plan enrollment of 19,300 by 2012 – an increase of over 14 % in decade

10. Increases in Entering Medical School Classes 1986-1987 16,779 0.74 % 1996-1997 16,904 2003-2004 17,118 1.27 % 2006-2007 17,880 4.45 % 2009-2010 18,400 3.40 % 2011-2012 18,665 0.52 % % Increase

11. Workforce Issues Projected Physician Shortage The limiting factor for increasing the number of physicians is the number of residency positions These positions are funded through Medicare, and are capped under the BBA of 1997 Medical schools have increased their enrolments 12 % over last four years Congress must raise limits on residency positions

12. Unmatched Prior US US DOs TOTAL Positions US MD MDs UNMATCHED in Seniors Scramble 2008 883 663 531 2,077 1,300 2009 1,072 677 605 2,354 1,087 2010 1,078 747 601 2,426 1,060 2011 971 764 617 2,352 1,035 As recently as 2001, there were 2,383 GY1 positions available in the Scramble. Now, for three years in a row, this number is less than half that. To make matters worse, most Scramble slots (606 of 1,035) are for preliminary positions in surgery (444), medicine (129), or transitional year (33), with no guarantee of future training. Unmatched US MDs and DOs and Scramble

13. An increasing number of US medical graduates will be unable to find residency positions that will lead to Board Eligibility/Certification These graduates will have a difficult time getting hospital or clinic appointments They will be qualified only for some of the lowest paying positions in medicine Their average debt will be over $ 156,000 US Graduates are Being Denied Residency Training

14. THE BIGGEST PROBLEM How to pay for Medical Education !

15. Tuition covers only 3.3% !

16. Graduating Medical Students Nine out of ten students carry outstanding debt The average medical student debt: $ 156, 171 Average residents income: $ 45,866

17. Medical School Debt

19. How Do Medical Students Pay for Their Education?

21. How to Pay for Graduate Medical Education ?

22. Medicare Support for Graduate Medical Education Total Cost for GME $ 9.5 Billion Direct Support $ 3.5 Billion Indirect Support $ 6.0 Billion Medicare Payment Advisory Commission (MedPac) Proposal (Oct 2011): Cut Indirect Support by $ 3.0 Billion dollars!

23. 1-800 833 6354

24. Teaching the Surgeons of the Future The pressure on resident work-hours is likely to continue We should be active in challenging some of the basic assumptions of the reductionists We should stress the importance of a chain of responsibility We should emphasize the consequences of shortened training We can not train residents to practice as we do – they will need to be much more efficient

25. It is likely that simulation will play an increasing role in our training

26. Teaching the Surgeons of the Future The Administration will announce a new $ 1 Billion program to expand the Healthcare workforce – this AM

27. Critical Time for Practice of Medicine ! The next two months will determine the fate of Medicines highest advocacy goals: Elimination of the Sustainable Growth Rate Formula Medical Liability Reform

28. SGR Elimination: Delay Means Higher Costs

29. Message to Congress A credible deficit reduction package should full repeal of the SGR Recent bipartisan proposals have achieved over $4 trillion in savings while repealing the SGR Recent SGR patches have increased the size of future cuts & the cost of full repeal Medical liability reforms will lower health care costs by curbing meritless cases and reducing the practice of defensive medicine.

30. We Must Act Now ! AMA will invest significant resources to demand SGR fix – will involve TV, radio, print and internet advertising Must include grassroots effort by physicians and patients We need your help!

31. Let Congress Hear from YOU! Ama-assn.org/ama/pub/advocacy/get involved.page Call Your Congressman – Toll-Free! 1 800 833 6354