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Threats to cut federal Medicare funds that pay for residency training for doctors have eased but not gone away since they were formally proposed by some members of the Congressional super committee last fall.

Dr. Peter Nalin, the associate dean of graduate medical education at the Indiana University School of Medicine—which funds more than 1,100 residents at any given time—said such cuts would be disastrous at a time when patient demands increasingly outstrip the supply of physicians.

IBJ: Some deficit-cutting plans called for reducing by as much as 30 percent the $10 billion in annual Medicare funding for the residencies that medical school graduates do in hospitals, before they practice on their own. What impact would those cuts have had here in Indiana?

A: It would have an immediate impact because the residents and fellows are a first source of access to care for many patients: emergency, family medicine, geriatrics. The residents and fellows deliver care in clinics and offices and the emergency room, so often it’s a resident or fellow—of course conducting clinical work under supervision—that helps the system see tens to hundreds of thousands of patients in a year. The replacement cost of all of that activity ... would far outstrip the savings and investment that occurs.

IBJ: Why couldn’t the IU medical school absorb those cuts and keep funding residency training?

A: This wasn’t going to be just trimming around the edges. This was going to be cuts to the core of the system. We’re in a decade of expansion of 30 percent nationally in enrollment in medical schools. There needs to be a 30-percent increase in [graduate medical education] funding, too, if we’re going to train more doctors.

IBJ: Has the IU medical school developed a contingency plan for dealing with such cuts, should they come to fruition?

A: Even the severest cuts that were proposed were going to be phased in over a number of years. If such severe cuts were to occur, we would have to inventory our deployment of every resource to figure out what that impact would be. It would have involved both the medical school and all the health systems with which we work. So far, we have had only preliminary discussions.

 

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  1. Those of you yelling to deport them all should at least understand that the law allows minors (if not from a bordering country) to argue for asylum. If you don't like the law, you can petition Congress to change it. But you can't blindly scream that they all need to be deported now, unless you want your government to just decide which laws to follow and which to ignore.

  2. 52,000 children in a country with a population of nearly 300 million is decimal dust or a nano-amount of people that can be easily absorbed. In addition, the flow of children from central American countries is decreasing. BL - the country can easily absorb these children while at the same time trying to discourage more children from coming. There is tension between economic concerns and the values of Judeo-Christian believers. But, I cannot see how the economic argument can stand up against the values of the believers, which most people in this country espouse (but perhaps don't practice). The Governor, who is an alleged religious man and a family man, seems to favor the economic argument; I do not see how his position is tenable under the circumstances. Yes, this is a complicated situation made worse by politics but....these are helpless children without parents and many want to simply "ship" them back to who knows where. Where are our Hoosier hearts? I thought the term Hoosier was synonymous with hospitable.

  3. Illegal aliens. Not undocumented workers (too young anyway). I note that this article never uses the word illegal and calls them immigrants. Being married to a naturalized citizen, these people are criminals and need to be deported as soon as humanly possible. The border needs to be closed NOW.

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  5. deport now

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