RESIDENCY TRAINING IN PHYSIATRICS DURING A TIME OF CHANGE - FUNDING OF GRADUATE MEDICAL-EDUCATION AND OTHER ISSUES

Decision makers at the federal and state level are considering, and so me states have enacted, a reduction in total United States residency p ositions, a shift in emphasis from specialist to generalist training, a need for programs to join together in training consortia to determin e local residency position allocation strategy, a reduction in funding of international medical graduates, and a reduction in funding beyond the first certificate or a total of five years. A 5-page, 24-item que stionnaire was sent to all physiatry residency training directors. The objective was to discern a descriptive database of physiatry training programs and how their institutions might respond to cuts in graduate medical education funding. Fifty-eight (73%) of the questionnaires we re returned. Most training directors believe that their primary missio n is to train general physiatrists and, to a much lesser extent, to tr ain subspecialty or research fellows. Directors were asked how they mi ght handle reductions in house staff such as using physician extenders , shifting clinical workload to faculty, hiring additional faculty, an d funding physiatry residents from practice plans and endowments. Phys iatry has had little experience (29%; 17/58) with voluntary graduate m edical education consortiums, but most (67%; 34/58) seem to feel that if a consortium system is mandated, they would favor a local or region al over a national body because they do not believe the specialty has a strong enough national stature. The major barriers to a consortium f or graduate medical education allocation were governance, academic, fi scal, bureaucratic, and competition.