Delaware native Alexandra Duszak is a 2011 Honors graduate of the University of Delaware, where she was executive editor of The Review, the university’s student newspaper. She will begin a year-long fellowship at the Center for Public Integrity in Washington DC in July. The issue discussed here is especially important to Alexandra because of her family’s positive experience when her younger sister was under the care of a pediatric ophthalmologist.
When President Obama released his proposed budget for 2012 in February, he also unveiled a seemingly severe strategy for reigning in the nation’s (admittedly) enormous deficit. While his plan to place a five-year freeze on discretionary spending is responsible fiscally, its social consequences are large and varied, even painful. The proposed budget would affect essential—though not necessarily obvious—programs, including one that plays a major role in A.I. duPont Hospital for Children’s ability to keep and train residents.
By federal standards, the cost of the Children’s Hospital Graduate Medical Education program is pocket change, but this program is essential for the nation’s 55 pediatric hospitals. The program helps fund the salaries of residents, and without it, hospitals like A.I. duPont would have difficulty staffing the number of residents needed to optimally care for their patients.
Residents—doctors fresh out of medical school who must undergo several years of additional real-world training—serve an essential function at teaching hospitals. Because they have graduated from medical school, they can provide quality care under the supervision of another physician. But because they are still residents, their services are available at a much lower cost.
Residencies allow hospitals to have more doctors on hand and to provide more consistent care. They also give young doctors the experience they need. It’s a win-win situation, and the federal government’s contribution to it is $268.4 million—a drop in the bucket for a government whose budget for 2012 is $3.7 trillion.
At A.I. duPont, $2.7 million of the hospital’s budget for residents comes through the CHGME program. If the program is eliminated, the hospital will lose 54 percent of the funding for its 300 residents. It will not be able to take on as many residents in the future, and will likely have to eliminate positions. It’s not as if the hospital would be trimming the fat; as is the case at many other hospitals, the residents at A.I. duPont fill the gaps created by the impossibility of paying a full staff of doctors to be available at all times. With resources spread thinner following the elimination of the program, patients’ quality of care will suffer. Furthermore, A.I. duPont and hospitals like it will not be able to effectively perform one of their essential functions—training new doctors.
A cut now will continue to have ill-effects years down the road, as it creates a strong possibility of exacerbating the current problem of a shortage of pediatric specialists. A.I. duPont currently enjoys a good reputation both regionally and nationally. In fact, U.S. News & World Report ranked Nemours, which owns and operates the hospital, among the nation’s best pediatric health systems in multiple subspecialties. But without the assistance of CHGME, training a sufficient number of new pediatricians will become prohibitively expensive, and a quality of care deserving of such rankings could elude the hospital and others like it.
What is certainly worse than a loss of prestige, however, is the effect a severe shortage of pediatricians will have on children in need. Pediatricians must act with elevated compassion and sensitivity when dealing with sick children and their families, and their knowledge of children’s diseases and children’s bodies is truly a specialty. Amidst the heartbreaking cases so often seen in a hospital setting, pediatricians must be able to think clearly and work effectively. The CHGME program helps provide training for such difficult circumstances for 40 percent of the nation’s pediatricians and 43 percent of pediatric subspecialists.
I do not mean to say that the CHGME program is more important than any other program that falls under the unfortunate category of non-defense discretionary spending, or that it should be reinstated when others clearly can not. I would merely like to point out that in relentlessly pushing for the passage of the Affordable Health Care Act, President Obama declared his support for widely accessible, affordable health care. It’s a shame that in his rush to enlarge the government, he failed to consider the other side of the issue: if patients are to be well cared for, they must be treated by doctors who have had the opportunity to learn.