Connecting Consumers with Special Problems to Top Specialists in Medical Centers – A Top-Level Innovation

Key words - Innovation, Health care reform, medical schools, primary care physicians, medical student incentives

Summary of An Interview with John Connolly, President of Castle-Connolly Medical Ltd

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Q: "Can you reflect on academic medical centers’ and their physicians’ attitudes towards health reform?"

A: "People in the academic medical world are deeply concerned and threatened. I don’t like to use the word “reform.” I prefer the term “proposals.” The health care proposals coming out of Congress and being supported by the President have a tremendous potential for doing harm to academic institutions in a number of ways."

"One, they are proposing substantial Medicare cuts. The proposals say they will cut Medicare expenditures by 20% over the next 10 years while his eligible Medicare population is increasing by 30%. That means a 50% reduction for each Medicare eligible person."

"A lot of these institutions depend heavily on Medicare. You may have noticed that a Mayo Clinic outlet in Arizona is not accepting new Medicare patients because the reimbursement is not enough. That’s a sign of the times, and you will see more of it in the future."

"Two,many academic centers bear a disproportionate share of caring for the uninsured. Many centers are located in inner cities. They carry huge burdens."

"Medicare cutbacks and Medicaid expansion will hurt them. There’s a call for expanding the Medicaid population by 30 million. The problem is the Medicaid reimbursement is so low hospitals and doctors lose money on every patient. You’re not going to meet your expenses by selling more of a losing product. Ask St. Vincent hospital in Greenwich Village. They’re going bankrupt providing compassionate care for the poor, HIV-infected , and the uninsured."

"On top of all this, under the new proposals, the government says it plans to control costs by rationing high tech procedures--the financial life blood of many academic centers."

"To sum up, academic institutions are feeling threatened. And for good reason."


Q: "What’s the best thing that could happen for the nation’s academic medical centers?"

A: "The best thing would be to provide medical students with additional financial aid based on need. Medical school tuition is so high that many students graduate with debts of $150,000 to $200,000. Give them financial aid. At the same time, provide financial incentives to direct more students into primary care."

"We also have to begin increasing the number of medical students. The government and the medical establishment opposed this increase for years. Right now one-third of the doctors practicing in the United States are foreign trained. There’s no need for that. There are plenty of able students in this country who would like to go to medical school. If we would increase the number of medical schools and the number of students, it would be a very good thing for our country. We should require, however, that more of them go into primary care and into under-served areas."

"We need to create incentives to funnel more students into primary care, and we need to require students who received financial aid for their education to practice in doctor-short regions. We have not done that in the past, and that was a grave mistake."