First Teach No Harm

The U.S. spends $13 billion a year subsidizing graduate medical education. Yet almost all of this money winds up producing the wrong kinds of doctors in the wrong places, with America’s most elite teaching hospitals being the worst offenders.

Perhaps you’ve noticed their full-page ads in your local newspaper. In late 2012, a new series began showing an anesthetized woman laid out on an operating table. The stark headline reads “BE CAREFUL WHAT YOU CUT.” The ad goes on to explain: “Reducing the deficit is essential. But at a time when our nation faces a critical shortage of doctors, cutting federal support for doctor training will jeopardize access to care and turn back the clock on life-saving cures and medical discoveries.”

These ads are brought to you by the Association of American Medical Colleges and are part of an extensive lobbying and public relations effort. At issue are some $13 billion in government subsidies that flow each year to medical residency programs, such as the kind depicted in the long-running, popular TV series Scrubs.

Under America’s system for educating doctors, medical school graduates may not practice on their own until they have first completed a period of on-the-job training know as residency, which typically last three to five years. Such training usually occurs in so-called “teaching hospitals” or academic medical centers, which offer residency slots in various specialty areas of medicine, such as dermatology or cardiology. If you’ve ever been treated in a teaching hospital, you may well have seen the drill in which a gray-haired attending physician comes to your bedside surrounded by a group of twentysomethings whom he quizzes about the lessons of your case.