Report

Abstract

In the US, the federal government is supposed to defer to the states on matters not reserved for it by the Constitution, such as regulating the medical profession. State medical boards, created and empowered by state legislatures, establish the criteria that must be met before physicians are issued licenses and allowed to care for patients without supervision. Since the latter half of the 19th century, the medical profession has been effectively regulating itself through heavy influence over the licensing process and control of the organizations that certify educational and training institutions. The federal government participates in (but does not directly control) residency programs through partial funding provided mainly by Medicare. Further, it writes the laws that regulate the influx of foreign graduates of international medical schools. The federal government should encourage a more adaptive and flexible pipeline of physicians entering the US market by (1) shifting away from the excessively hospital-centric orientation of current funding for residency training and directing the aid to the residents themselves; (2) promoting new forms of institutional certification with fewer ties to the economic interests of existing practitioners and academic medical centers; (3) adjusting the Medicare fee schedule, which sets income expectations for physicians, based on the market prices revealed through transparency initiatives; (4) promoting and testing a shorter and less costly education option that merges a traditional undergraduate curriculum with medical school; and (5) enacting immigration policies that accommodate a larger influx of well-trained and talented foreign-born physicians.

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