Graduate Medical Education Legislation Is Introduced in Congress

Senators Susan Collins (R-Me.) and Frank Murkowski (R-Alaska) introduced the Graduate Medical Education Technical Amendments of 1999 (S. 541) on March 4. The bill is almost identical to legislation they both introduced in 1998. Like last year's bill, this one would treat fairly and equally all hospitals with residency programs that train residents in nonhospital settings. Currently, federal law allows indirect medical education payments only for resident positions assigned out of the hospital for the first time in 1997 and beyond. Hospitals that already were training residents in ambulatory settings in 1996 do not have the right to reimbursement. The new bill also allows several new residencies under development in 1997 to open their doors, with Medicare support, and enables Medicare GME payments to urban hospitals that sponsor new rural training tracks as an exception to new GME funding caps on such hospitals. The bill also allows Medicare GME support for limited growth for about 300 hospitals that sponsor a single residency program—most often a family medicine program. Up to one new position per year or up to a total of three new positions would be allowed.

Representatives Thomas H. Allen (D-Me.) and John E. Baldacci (D-Me.) expect to introduce a similar or identical bill in the House of Representatives very soon. The American Academy of Family Physicians (AAFP) has been a strong supporter of this bill and will work hard to promote its passage this year.

Eleven National Medical Associations Join to Prevent Pneumonia

The AAFP, the American Medical Association (AMA) and nine other medical societies have issued a joint health alert calling for more extensive use of immunizations to combat increasingly resistant strains of bacteria that cause pneumonia. Recent evidence shows that the rate of immunizations against pneumonia is as low as 45 percent in persons over age 65. In addition to persons over age 65, the organizations recommend that all persons at increased risk of contracting Streptococcus pneumoniae bacterium be immunized. To avoid missed opportunities, all persons at increased risk of infection should have their immunization status assessed, when feasible, during any health care encounter. The currently available vaccine is not recommended for children under two years. For additional information, contact the National Immunization Program at 404-639-8254 or the National Center for Infectious Diseases at 404-639-2215. A copy of the alert can be found on the Web site of the AMA at http://www.ama-assn.org.

Initial Fill Rates for Family Practice Residency Programs Are Announced

Preliminary information available from the National Resident Matching Program indicates that the initial 1999 national fill rate for family practice residency programs is 2,697 positions filled out of 3,265 available positions (82.6 percent). In 1998, the initial number of students who selected family practice was 2,814 (85.5 percent of the 3,293 available positions). This is the second year that the match program has experienced a decrease in positions filled. In 1997, the initial number of students who selected family practice was 2,901 (89.1 percent of the 3,262 available positions). The percentage of students matching with family practice residencies has ranged from 65.0 percent in 1991 to the record of 90.5 percent in 1996. The 1999 figure, while down from 1998, is still one of the highest matches for family practice in history. “The number of third-year medical students who have joined the AAFP is significantly greater than the number of current fourth-year student members,” said Lanny Copeland, M.D., president of the AAFP. “There is reason to believe that more of next year's fourth-year students will pursue family medicine.” The number of graduating seniors who have joined AAFP is 4,655, compared with 5,403 third-year seniors.

In addition to family practice, two of the three other primary care specialties have had fewer students choosing their residency programs. These include internal medicine-primary and internal medicine-pediatrics. The category pediatrics-primary experienced an increase in positions filled. Overall, 24,462 individuals participated in the match this year. Detailed information on the 1999 residency match program can be found on the AAFP Web site (https://www.aafp.org/match/) or the Web site of the Association of American Medical Colleges (http://www.aamc.org).

AAFP Supports Managed Care Reform Act

For the past two- and one-half years, bills that would establish the rights of patients in managed care plans have held center stage in the U.S. Congress and most state legislatures as well. In the summer of 1998, the House of Representatives passed a managed care reform act by a very narrow margin. No comparable bill passed the Senate and the past Congress adjourned without action on this important issue. The AAFP has felt that it is very important to establish, define and support the rights of patients in the managed care environment. On March 19, AAFP Board Chair Neil Brooks, M.D., wrote Congressman Greg Ganske (R-Iowa), a plastic and reconstructive surgeon, in support of H.R. 719, his Managed Care Reform Act of 1999, following endorsement of the bill by the AAFP board.

H.R. 719 is the first bill that secures patients' rights successfully, “without overregulating the practice of medicine, or compromising the role of primary care physician in plans,” according to Brooks, who also thanked Representative Ganske for his willingness to listen to AAFP physicians and other primary care physicians. For example, the Ganske bill provides that nonprimary care specialists may manage the care for an enrollee's particular outgoing special condition, but some other bills designate these specialists as “primary care physicians” and allow them to provide all primary and specialty care of the patient.