Administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations; direct grant programs--DoE. Final regulations

The Secretary amends 34 CFR parts 74 and 75 to add the Office of Management and Budget (OMB) control numbers to certain sections of the regulations. Those sections contain information collection requirements approved by OMB. The Secretary takes this action to inform the public that these requirements have been approved.

The growth of postdoctoral general dentistry programs

From 1972 to 1990, the number of Postdoctoral General Dentistry (PGD) programs increased by 57% and enrollment increased by 57% and enrollment increased by 131% for a total of 118 PGD programs and 1,367 positions. Although there has been some increase in military and Veterans Affairs (VA) programs, the major increase was in civilian programs. From 1972-78, the major impetus for growth was hospital sponsorship of General Practice Residency (GPR) programs. With federal funding of PGD programs, civilian GPR programs continued to be the main source of growth until the accreditation of Advanced Education in General Dentistry (AEGD) programs in 1981. Subsequently, almost all increases were in AEGD programs. Over the 12-year period of federal funding (1978-90), there was an increase of 406 civilian PGD positions to make a total of 925 positions. The increase in enrollment directly attributable to federal funding was 242. The "unmet demand" for PGD programs was estimated to be approximately 300 positions for 1990, from data derived from the Survey of Dental Seniors and the Matching Program. Assuming that the number of PGD positions continues to increase by 35 positions a year, as it has in the past 12 years, the unmet demand would be met in slightly less than 10 years. If, however, a postdoctoral year was mandated for licensure, the increase in the number of positions would be far short of projected need.

Time is running out for entitlement reform

In 1993, President Clinton created the Bipartisan Commission on Entitlement and Tax Reform as part of the administration's effort to promote economic growth and control the budget deficit. The purpose of the commission, chaired by Senator J. Robert Kerrey (D-NE) and Senator John C. Danforth (R-MO), is to seek bipartisan agreement on long-term entitlement reform and structural changes to the tax system. The final recommendations of the commission, due December 15, will be of great interest to the academic medicine community because of the importance of federal dollars to medical research and education and the crucial role of the Medicare and Medicaid programs in financing the care provided by teaching physicians and teaching hospitals. What follows is a summary of the commission's interim report submitted to the president on August 8; it reflects the commissioners' almost unanimous (30 to 1) agreement on the nature and magnitude of the entitlement problem.

Health professions education. The shaping of a discipline through federal funding

The federal government has been the single most dominant force shaping the development of health professions over the past 50 years. Described as both a patron and proprietor of health professions education, the federal government's role is a factor that health professionals cannot ignore. This article focuses on the three major federal initiatives (Veterans Administration training programs, Title VII of the Public Health Service Act, and Medicare's Graduate Medical Education) which have most significantly influenced the training in and development of the disciplines of psychology and medicine. The significance for psychology's involvement in national health policy, particularly during this era of reform, is highlighted.

Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations, and with commercial organizations, foreign governments, organizations under the jurisdiction of foreign governments, and international organizations--DOL. Final rule

The Department of Labor is issuing these regulations pursuant to the requirements of the Office of Management and Budget (OMB) Circular No. A-110 (Revised), which provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. This rule also applies to the Department of Labor's grants to commercial organizations, foreign governments, organizations under the jurisdiction of foreign governments and international organizations. OMB issued Circular A-110 in 1976 and, except for a minor revision in February 1987, the Circular remained unchanged until revised in 1993. To update the Circular, OMB established an interagency task force to review the Circular. The task force solicited suggestions for changes to the Circular from university groups, non-profit organizations and other interested parties and compared for consistency the provisions of similar provisions applied to State and local governments. The revised Circular and these regulations reflect the results of these efforts.

Reinstating nursing administration graduate study in federal nurse traineeships

In 1992, the federal guidelines for funding nurse traineeships were amended to exclude nurses who pursue advanced degrees in nursing administration. This legislation expires soon, and final drafting of new legislation will be completed during the summer of 1994. The author presents information to use in advocating for reinstatement of nursing administration students as potential recipients of federal nurse traineeship dollars for advanced education.

Supporting primary care medical education

A number of fundamental issues must be considered in preparing the education system to produce more primary care physicians. Governmental controls and redirection of resources will force significant changes in the structuring of approaches to both undergraduate and graduate education in primary care. Particularly challenging will be restructuring and funding medical student programs in primary care, given a nearly certain requirement that more than 50% of medical school graduates enter primary care disciplines. Institutions will need to make strategic resource allocations to compete for the funding once the allocation process begins. Educational institutions will also face a cultural adaptation to primary care as an educational priority. This paper presents a model to study costs and funding for residency programs as they move from the traditional inpatient orientation to an outpatient focus. The authors suggest that for medical student education, the development of large academic health care systems may make funding primary care education more feasible.

Putting a price tag on training new doctors

The nation's teaching hospitals depend heavily on $5.2 billion in annual federal payments for graduate medical education, but few of them know what portion pays for patient care and what portion supports teaching activities. Because hospitals and medical schools will continue to confront funding cutbacks under health reform, they must learn how to quantify the revenue and expenses associated with each activity to receive adequate compensation.

Education and the health professions: explaining policy choices among the states

Recent calls for restructuring of the nation's health care system have highlighted the deficiencies in the current system of education for the health professions. Of particular concern are the dominance of specialization and hospital-based training and the tendency of new health care providers to settle in communities without substantial health needs. The states are the key actors in reforming health professions education, serving as a primary funding source for health professions schools, chief licensors and regulators of health professions, regulators of private health insurance, key providers of Medicaid, and architects of a variety of subsidy and regulatory programs providing incentives for health professionals to choose specialties and locations for practice. This article provides a taxonomy of state policies affecting health professions education reform and classifies the states according to the choices they have made. Findings show that few states take advantage of their policy options across the four policy types and that most tend to concentrate their efforts on a few policies--ignoring potential means of encouraging more primary care providers in underserved areas. Results from regression models explaining state choice of policy adoption highlight the political nature of policy choice and the highly variable nature of state response in health professions education reform.

U.S. Federal Government attempts to promote primary care training

The federal government of the United States is concerned that only 30-33% of physicians are in primary care practice and not more than approximately 15-20% of recent medical graduates choose primary care. Moreover, the distribution of interns and residents in primary care in recent years is 40% and after "branching" it is realistically only 25%. The federal government's goal through legislative intervention is to increase the pool of U.S. medical graduates to enter primary care from the current level to at least 50% by the turn of the century. To attain this goal, the government is depending on health care reform legislation and making changes in federal legislation that reimburses graduate medical education through direct and indirect Medicare payments. The federal government hopes to produce incentives to increase the pool of primary care physicians and to place disincentives on subspecialty training by altering direct and indirect Medicare payments in favor of primary care training programs; by limiting residency and fellowship slots; and by removing limits on direct payments at ambulatory care sites for training, including non-hospital settings. There is concern among medical educators that these changes in current legislative interventions will not increase to 50% the numbers of medical graduates choosing primary care careers. Accredited residency and fellowship programs need to assess projected manpower needs immediately to justify their positions for achieving a balanced physician workforce for the twenty-first century.

Culture shock: two medical schools grapple with new demands for primary care doctors

By nearly any standard--federal research dollars, faculty credentials, and student career plans--the medical schools of East Carolina University and Johns Hopkins are as different as day and night. But both agree that Washington's efforts to boost the number of generalist physicians are inadequate.