In the April 2005 issue of the GME E-letter, we wrote, "A headline in the current JAMA flashes like neon: "Pharmaceutical Industry Funding for Residencies Sparks Controversy." Indeed! At a time when the public is increasingly concerned about drug companies' influence on physicians' practices, the American Academy of Dermatology's decision to use industry funding to expand residency training raises important issues.
"Is the drug industry's willingness to contribute to the cost of GME a gift horse or a Trojan horse?"
Following are edited versions of the comments received, with identifying information removed.
Certainly, with industry money comes risks. However, funding to academic centers for resident education does not necessarily cover all resident positions, and, to my knowledge, the number of positions that the government funds at a given institution is fairly fixed. This results in institutions having to pay for positions. In this day of shrinking margins, that is a serious problem for academic medical centers. Nothing comes for free.
My vote: Trojan horse.
Alarmed—yes I am. However, I am not surprised at the least. With continued cutbacks in financial support, adjustments due to work hour restrictions, and ever-increasing administrative unfunded mandates, programs are going to begin turning toward "creative financing." Is advertising on the back of lab coats far off?
Regards,
A Diplomate of the ABPN, a Division of the Starbucks Corporation
Excellent topic and certainly a very important question. Already in academics the "grant support" for "research" has certainly muddied the waters in recent years. This grant money comes of course not only from the pharmaceutical companies but technology companies. Though our politicians seem all but willing to drag highly placed NIH officials over the coals for working relationships with the drug and technology industry (for example, Dr. Liotta), the same politicians appear to be backing away from the CMS support of GME funding.
Here the State of Texas (beginning during the Bush administration) cut off Medicaid funding of GME. A lot of our GME funding has thus fallen upon the local institutions and local tax base.
Great job of getting the word out. Hope everyone forwards this to their senators and congressmen.
Too many of our institutions do not provide support. Mine included! I work extra hours on research projects just to receive grant money for resident support. We need funding. I am glad the pharmaceutical industry is helping. Individual physicians will not be affected by large-scale funding such as this. The direct gracious recipient is the program or group who received the money. The residents acknowledge the gift but really only see their primary program and attending helping them. They don't feel a huge, direct impact of a specific pharmaceutical company.
Our government, hospitals, and our own public need to help. Too many people feel doctors make enough money and forget all the tough years of lost pay, countless hours, and sacrifice these residents endure. There is already a nursing shortage. I haven't seen any significant push to increase pay or promote nursing. Physicians are next. Why should someone work countless hours and be on call 24/7 when they could make the same money in finance, business, or computers? One of the answers is self-sacrifice and the desire to help others. Many physicians have this innate self-sacrificial quality, but also learn this by watching others. We need funds and support for GME.
We are in the midst of a crisis. Less qualified applicants, lower number of residents, yet more retirees. We don't want to grow old and not have adequate medical care.
I'm happy that someone is helping, and I'm glad the ACGME is working on stricter institutional guidelines for support of residencies. We need all the support we can get.
Bravo!
This is not a new concept; when I was in infectious diseases training 27 years ago the salary of one of the other I.D. fellows had been provided to pursue research related to an anti-infective drug. This did not corrupt the physician in training and provided an avenue for education not otherwise available.
I would be very wary of linking graduate medical education to pharm funding.
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