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    Outlook for healthcare under a President Trump


    Impact on graduate medical education and research

    Perhaps nowhere is the threat of radical change greater than financing of graduate medical education (GME). It is unclear precisely where President-elect Trump stands on the issue of Medicare support for hospital-based resident and fellowship training. Stopping such support could result in catastrophic reductions in training slots with many US medical student graduates unable to match. Organized medicine is likely to put up a strong fight over such reduced funding but, as a medical school dean, this is one of my greatest fears, particularly since many medical schools are already facing competition for GME slots from Caribbean-based programs that offer to pay for residency opportunities.

    Early casualties of Mr Trump’s election may include the Center for Medicare and Medicaid Innovation, the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, and the many grants and pilot projects they now support. National Institutes of Health (NIH) funding could also be at risk.

    Mr Trump plans to slash corporate and personal income tax rates while funding large-scale infrastructure improvements and increased military spending. While that may act as a potent fiscal stimulant to the economy, it may also trigger either inflation or draconian cuts in non-entitlement/non-defense components of the federal budget to avoid massive deficits. In any event, NIH funding could be on the chopping block. Since 2003, the NIH has lost 22% of its funding when adjusted for biomedical inflation.2 With many NIH institute paylines now below 10%, we are already at risk of losing a generation of young scientists and ob/gyn departments are at particular risk. Further cuts would be unsustainable.


    Charles J. Lockwood, MD, MHCM
    Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...


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