Op-Ed: The Impact of Proposed Medicare Cuts on New York’s Teaching Hospitals

In Washington,  federal funding to support New York’s teaching hospitals has become a target in ongoing cutback negotiations. As the New York Times reports, New York City is a mecca for educating America’s doctors, training up to 16,000 of them a year (about 14.5 percent of the nation’s total).

MetroFocus invited The Mount Sinai Medical Center President and CEO Dr. Kenneth L. Davis to comment on the impact the proposed cuts would have on the institution and the region.

Yasmin Hurd, PhD, Director of the M.D./Ph.D. program (center), and her team setting up an experiment to analyze gene expression patterns in the brain. Photo courtesy of The Mount Sinai Medical Center, 2010.

Congress and the Obama administration are considering many proposals to significantly reduce federal spending. Without question, our nation cannot continue to borrow 40 percent of its annual budget and sustain a mounting federal debt, which currently exceeds $14 trillion.

However, it would be unconscionable to promote any proposal that would undermine the health and well-being of our citizens — and the recommendations to reduce Medicare Graduate Medical Education (GME) funding would do just that. These cuts would choke America’s teaching hospitals — institutions that represent just 6 percent of all hospitals but that provide 41 percent of all free care and nearly one-quarter of all discharges. Make no mistake: every one of the nation’s 900 teaching institutions would be affected, and most especially those in urban areas such as New York, Boston, Chicago and Los Angeles.

Academic medical centers such as Mount Sinai provide a wide range of services to the community — from primary care at our clinics, to emergency treatment and some of the most advanced care available in the world. These include organ transplantation units, intensive care facilities for newborns and children as well as highly specialized services in the treatment of heart disease, cancer and neurological disorders.

Karen Zier, Ph.D., Associate Dean for Medical Student Research (center), reviewing experimental results with students. Photo courtesy of The Mount Sinai Medical Center, 2010.

For Mount Sinai, the proposed cuts could result in a loss of more than $80 million in annual revenue. The reductions would come on the heels of cuts that are already being phased in to help subsidize health care reform and that are estimated to have a net negative impact of approximately $450 million on our institution over the first 10 years. In the face of this, Mount Sinai will already have to reduce our $1.4 billion operating budget by 6 to 8 percent. To address additional losses of such a magnitude, Mount Sinai would need to take more drastic measures to slash its spending. Doing so would result in the reduction or elimination of services for the communities in the region.

The proposed cost-savings measures could mean the elimination of at least 100 residency positions, many in primary care programs such as internal medicine, pediatrics, emergency medicine and geriatrics. This, in turn, would worsen the nation’s shortage of physicians.

The American Association of Medical Colleges estimates  a national deficit of at least 90,000 physicians by 2020, and 125,000 by 2025. Here is why.  Currently, there are only about 700,000 active physicians in the United States — for a population of over 310 million — and nearly one-third of our doctors will retire in the next decade. Meanwhile, the U.S. Census Bureau projects a 36 percent growth in the number of Americans over age 65 in the next 10 years. Older patients are sicker and have multiple chronic conditions that require more medical care. Add to that the estimated 32 million Americans who will gain access to medical insurance as a result of recent health care reforms.

Clearly, America should be training more physicians rather than fewer, but draconian cuts to medical education would leave us little other choice.

Stuart Aaronson, M.D., Chair of the Department of Oncological Sciences, and a member of his team preparing for a tissue culture experiment. Photo courtesy of The Mount Sinai Medical Center, 2010.

The fate of community programs that have been maintained despite annual operating losses would likewise hang in the balance.  These include hospital clinics that are the sole health care provider for many of our neighbors, and primary care facilities that treat thousands of patients but incur the largest annual losses. Outreach services such as the nation’s few house-call programs for home-bound patients — Visiting Doctors at Mount Sinai is the largest and a model in the United States — and preventive health screening programs for high blood pressure, cholesterol and diabetes would also be in jeopardy.

In short, at the nation’s academic medical centers like ours, there would be no refuge from cuts to medical education.  And there would be detrimental effects to public health. While I applaud Congress and the administration for trying to rein in federal spending, for the health of the nation and longer-term fiscal prudence, they should reject these proposed cuts.

Dr. Kenneth L. Davis is President and Chief Executive Officer of The Mount Sinai Medical Center in New York City.

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