Joel B. Finkelstein

WASHINGTON — Strained by rising demand and insufficient resources, the nation's emergency care is in a precarious state, an Institute of Medicine expert panel has concluded, and Congress must act to shore up the system.

Emergency departments are closing, the pool of available on-call specialists is drying up, and access to timely care in an appropriate setting is on the decline, warned Dr. A. Brent Eastman, chief medical officer of Scripps Health in San Diego, at the public release of the report compiled by the IOM's Committee on the Future of Emergency Care in the U.S. Health System.

The emergency care system's troubles are an especially frightening reality considering that it has traditionally provided the care of last resort, catching those unfortunate patients who have slipped through the gaps of the health care safety net, Dr. Eastman added. There is no longer any guarantee that it will be there when those patients need it, he cautioned at the meeting on emergency care sponsored by the Institute of Medicine.

The IOM panel recommended that Congress establish a single lead agency to oversee and manage emergency care, pulling together resources that are now currently overseen by an array of departments within various agencies, including the Department of Health and Human Services, the Department of Homeland Security, and the Department of Transportation.

As the committee envisioned it, that new lead agency would have planning and budgetary authority over the majority of emergency care activities at the federal level. Such an agency could raise the visibility of emergency medicine and emphasize the need to fund it. The agency would also coordinate how those federal dollars are spent.

Among other recommendations, the panel urged Congress to fund a demonstration program, to the tune of $88 million a year for 5 years, to assess strategies to coordinate and streamline the emergency care system. Federal agencies also need to support the development of national standards for measuring performance, the IOM said.

The report documents a host of issues besetting the emergency care system, including crowding, boarding, and diversions.

“The signs of distress are unmistakable,” said Dr. Arthur Kellermann, an IOM committee member and professor of emergency medicine at Emory University in Atlanta.

Over the past decade, visits to the emergency department—now up to about 114 million a year—have risen twice as fast as population growth. During the same period, the number of EDs shrank by 425, and the number of inpatient hospital beds fell by nearly 200,000.

“Do the math—with more people needing care and few resources available to provide that care, crowding in the ED was inevitable,” Dr. Kellermann said.

And with fewer hospital beds available, more severely ill and injured patients are boarded in the emergency department's exam rooms or even hallways until an inpatient bed can be made available.

“Some of them wait for hours, others wait for days. Meanwhile, other emergency patients are arriving every hour,” he said.

Often, EDs have no alternative but to divert inbound ambulances to other facilities. “When I started in my career, this was considered a rare and disturbing event,” Dr. Kellermann said. “It now happens more than half a million times a year in the United States.”

Demand Outpaces Resources

Emergency department responsibilities have grown over the years, with many now being expected to provide primary care to the uninsured, diagnostic services at night or on the weekend, and behavioral health care to the community.

Meanwhile, revenue has not kept pace. Medicare and Medicaid pay below cost for many emergency services, and uncompensated care has risen.

The emergency department is considered such an important public good that it is the only medical service that all Americans have a legal right to access. But hospitals are expected to finance that care through the free market system, Carmela Coyle, senior vice president for policy at the American Hospital Association, said during a briefing the day before release of the IOM report.

And because of low, and sometimes no, reimbursement, hospitals are finding it increasingly difficult to convince specialists to agree to be on call to the emergency department. Liability, especially in a setting where many uninsured patients are in poor health, is also a major concern for specialists, according to an AHA survey.

“It's tough to get called two, three o'clock in the morning to come in for a case where you know you might not get paid and you might get sued,” Ms. Coyle said.

Some hospitals have begun to pay specialists a retainer to be on-call, but that is just another financial burden making emergency departments a money-losing proposition, she said.

Stress on the System

Such financial difficulties have led to the closing of scores of emergency departments, which places more pressure on the remaining facilities.

Hospitals aren't inclined to give up inpatient beds to admit patients from the emergency department, who may pay at Medicaid rates or not at all, Dr. Kellermann said.

“Right now, all the incentives are to leave the patient in the ED so that they can keep admitting electives. You are financially penalized for making the right decision for patient care, because it is the wrong decision for your business,” he said.

The IOM committee also concluded that the emergency care system is not equipped to cope with a large-scale emergency.

“You've got to ask yourself, 'If our emergency departments are struggling to handle their daily and nightly load of 911 calls, how in the world are they going to handle a mass casualty event following a terrorist strike, an outbreak of infectious disease, or a natural disaster?” Dr. Kellermann said.

Federal funding for emergency preparedness has been and remains inadequate, the committee found. In 2002 and 2003, emergency care providers received 4% of $3.38 billion in first-responder funding distributed by the Department of Homeland Security—although emergency medical services personnel make up one-third of first responders. That has left EMS providers with scant training or planning to deal with a disaster situation.

Time to Act

The committee's findings show that emergency departments cannot continue to operate without more financial support, said Dr. Rick Blum, president of the American College of Emergency Physicians.

“Hospitals must be reimbursed for the significant amounts of uncompensated emergency and trauma care they provide,” he said in a statement.

Dr. Blum called for Congress to hold hearings on the state of emergency medicine and to pass the Access to Emergency Medical Services Act, introduced in the House last September and in the Senate in May 2006. The legislation targets several problems addressed in the report, including boarding, the lack of on-call specialists, and poor reimbursement for emergency care services.

Although emergency care on the whole is deeply troubled, the IOM committee found that there are islands of excellence—a select few facilities that have developed innovative approaches to dealing with the problems that all emergency departments face. Those islands provide a starting point on which to build a better system, committee members said.

“Our goal should be for these islands to coalesce and eventually blanket the United States with an emergency care system that has no holes,” Dr. Eastman said.

The panel envisioned a new regionalized system to coordinate care, so that patients are only taken to facilities that are appropriate and prepared to care for them, he said.

“Where there is no vision, the people perish,” Dr. Kellermann said. “Our committee has described a vision for a coordinated, regionalized, and accountable emergency care system. It's time to act.”

Gaps Noted in EMS, Pediatric Services

Problems with the state of hospital-based emergency care received the most focus in the release of the Institute of Medicine reports, but two accompanying reports highlight systemic issues with emergency medical services and pediatric emergency care.

Ambulance and other emergency medical services suffer from fragmentation that has led to critical problems in efficiency, efficacy, and coordination, according to the committee's report on emergency medical services.

The system is severely lacking in data to drive, or even gauge, performance. What few data do exist point to wide variations between communities, said committee member Shirley Gamble, chief operating officer for United Way Capital Area of Austin, Tex.

“There is as much as a 10-fold difference by community in survival rates for sudden cardiac arrest,” she said.

The committee also found that the patchwork nature of emergency medical services creates barriers to communication among emergency medical service providers and between those providers and emergency departments.

Children represent 27% of the country's 110 million emergency visits, but they often inappropriately receive adult-sized care, according to a committee report on emergency care for children.

“Many hospitals and EMS agencies may lack smaller-size medical equipment that is needed to care for these patients, and many providers receive limited training in pediatric emergency care,” said Dr. Marianne Gausche-Hill, director of prehospital care at Harbor-UCLA Medical Center in Torrance, Calif. Also, many medications used in the emergency department are given to children off-label, Dr. Gausche-Hill said, because they have not been approved by the Food and Drug Administration for pediatric use.

WASHINGTON — Strained by rising demand and insufficient resources, the nation's emergency care is in a precarious state, an Institute of Medicine expert panel has concluded, and Congress must act to shore up the system.

Emergency departments are closing, the pool of available on-call specialists is drying up, and access to timely care in an appropriate setting is on the decline, warned Dr. A. Brent Eastman, chief medical officer of Scripps Health in San Diego, at the public release of the report compiled by the IOM's Committee on the Future of Emergency Care in the U.S. Health System.

The emergency care system's troubles are an especially frightening reality considering that it has traditionally provided the care of last resort, catching those unfortunate patients who have slipped through the gaps of the health care safety net, Dr. Eastman added. There is no longer any guarantee that it will be there when those patients need it, he cautioned at the meeting on emergency care sponsored by the Institute of Medicine.

The IOM panel recommended that Congress establish a single lead agency to oversee and manage emergency care, pulling together resources that are now currently overseen by an array of departments within various agencies, including the Department of Health and Human Services, the Department of Homeland Security, and the Department of Transportation.

As the committee envisioned it, that new lead agency would have planning and budgetary authority over the majority of emergency care activities at the federal level. Such an agency could raise the visibility of emergency medicine and emphasize the need to fund it. The agency would also coordinate how those federal dollars are spent.

Among other recommendations, the panel urged Congress to fund a demonstration program, to the tune of $88 million a year for 5 years, to assess strategies to coordinate and streamline the emergency care system. Federal agencies also need to support the development of national standards for measuring performance, the IOM said.

The report documents a host of issues besetting the emergency care system, including crowding, boarding, and diversions.

“The signs of distress are unmistakable,” said Dr. Arthur Kellermann, an IOM committee member and professor of emergency medicine at Emory University in Atlanta.

Over the past decade, visits to the emergency department—now up to about 114 million a year—have risen twice as fast as population growth. During the same period, the number of EDs shrank by 425, and the number of inpatient hospital beds fell by nearly 200,000.

“Do the math—with more people needing care and few resources available to provide that care, crowding in the ED was inevitable,” Dr. Kellermann said.

And with fewer hospital beds available, more severely ill and injured patients are boarded in the emergency department's exam rooms or even hallways until an inpatient bed can be made available.

“Some of them wait for hours, others wait for days. Meanwhile, other emergency patients are arriving every hour,” he said.

Often, EDs have no alternative but to divert inbound ambulances to other facilities. “When I started in my career, this was considered a rare and disturbing event,” Dr. Kellermann said. “It now happens more than half a million times a year in the United States.”

Demand Outpaces Resources

Emergency department responsibilities have grown over the years, with many now being expected to provide primary care to the uninsured, diagnostic services at night or on the weekend, and behavioral health care to the community.

Meanwhile, revenue has not kept pace. Medicare and Medicaid pay below cost for many emergency services, and uncompensated care has risen.

The emergency department is considered such an important public good that it is the only medical service that all Americans have a legal right to access. But hospitals are expected to finance that care through the free market system, Carmela Coyle, senior vice president for policy at the American Hospital Association, said during a briefing the day before release of the IOM report.

And because of low, and sometimes no, reimbursement, hospitals are finding it increasingly difficult to convince specialists to agree to be on call to the emergency department. Liability, especially in a setting where many uninsured patients are in poor health, is also a major concern for specialists, according to an AHA survey.

“It's tough to get called two, three o'clock in the morning to come in for a case where you know you might not get paid and you might get sued,” Ms. Coyle said.

Some hospitals have begun to pay specialists a retainer to be on-call, but that is just another financial burden making emergency departments a money-losing proposition, she said.

Stress on the System

Such financial difficulties have led to the closing of scores of emergency departments, which places more pressure on the remaining facilities.

Hospitals aren't inclined to give up inpatient beds to admit patients from the emergency department, who may pay at Medicaid rates or not at all, Dr. Kellermann said.

“Right now, all the incentives are to leave the patient in the ED so that they can keep admitting electives. You are financially penalized for making the right decision for patient care, because it is the wrong decision for your business,” he said.

The IOM committee also concluded that the emergency care system is not equipped to cope with a large-scale emergency.

“You've got to ask yourself, 'If our emergency departments are struggling to handle their daily and nightly load of 911 calls, how in the world are they going to handle a mass casualty event following a terrorist strike, an outbreak of infectious disease, or a natural disaster?” Dr. Kellermann said.

Federal funding for emergency preparedness has been and remains inadequate, the committee found. In 2002 and 2003, emergency care providers received 4% of $3.38 billion in first-responder funding distributed by the Department of Homeland Security—although emergency medical services personnel make up one-third of first responders. That has left EMS providers with scant training or planning to deal with a disaster situation.

Time to Act

The committee's findings show that emergency departments cannot continue to operate without more financial support, said Dr. Rick Blum, president of the American College of Emergency Physicians.

“Hospitals must be reimbursed for the significant amounts of uncompensated emergency and trauma care they provide,” he said in a statement.

Dr. Blum called for Congress to hold hearings on the state of emergency medicine and to pass the Access to Emergency Medical Services Act, introduced in the House last September and in the Senate in May 2006. The legislation targets several problems addressed in the report, including boarding, the lack of on-call specialists, and poor reimbursement for emergency care services.

Although emergency care on the whole is deeply troubled, the IOM committee found that there are islands of excellence—a select few facilities that have developed innovative approaches to dealing with the problems that all emergency departments face. Those islands provide a starting point on which to build a better system, committee members said.

“Our goal should be for these islands to coalesce and eventually blanket the United States with an emergency care system that has no holes,” Dr. Eastman said.

The panel envisioned a new regionalized system to coordinate care, so that patients are only taken to facilities that are appropriate and prepared to care for them, he said.

“Where there is no vision, the people perish,” Dr. Kellermann said. “Our committee has described a vision for a coordinated, regionalized, and accountable emergency care system. It's time to act.”

Gaps Noted in EMS, Pediatric Services

Problems with the state of hospital-based emergency care received the most focus in the release of the Institute of Medicine reports, but two accompanying reports highlight systemic issues with emergency medical services and pediatric emergency care.

Ambulance and other emergency medical services suffer from fragmentation that has led to critical problems in efficiency, efficacy, and coordination, according to the committee's report on emergency medical services.

The system is severely lacking in data to drive, or even gauge, performance. What few data do exist point to wide variations between communities, said committee member Shirley Gamble, chief operating officer for United Way Capital Area of Austin, Tex.

“There is as much as a 10-fold difference by community in survival rates for sudden cardiac arrest,” she said.

The committee also found that the patchwork nature of emergency medical services creates barriers to communication among emergency medical service providers and between those providers and emergency departments.

Children represent 27% of the country's 110 million emergency visits, but they often inappropriately receive adult-sized care, according to a committee report on emergency care for children.

“Many hospitals and EMS agencies may lack smaller-size medical equipment that is needed to care for these patients, and many providers receive limited training in pediatric emergency care,” said Dr. Marianne Gausche-Hill, director of prehospital care at Harbor-UCLA Medical Center in Torrance, Calif. Also, many medications used in the emergency department are given to children off-label, Dr. Gausche-Hill said, because they have not been approved by the Food and Drug Administration for pediatric use.

WASHINGTON — Strained by rising demand and insufficient resources, the nation's emergency care is in a precarious state, an Institute of Medicine expert panel has concluded, and Congress must act to shore up the system.

Emergency departments are closing, the pool of available on-call specialists is drying up, and access to timely care in an appropriate setting is on the decline, warned Dr. A. Brent Eastman, chief medical officer of Scripps Health in San Diego, at the public release of the report compiled by the IOM's Committee on the Future of Emergency Care in the U.S. Health System.

The emergency care system's troubles are an especially frightening reality considering that it has traditionally provided the care of last resort, catching those unfortunate patients who have slipped through the gaps of the health care safety net, Dr. Eastman added. There is no longer any guarantee that it will be there when those patients need it, he cautioned at the meeting on emergency care sponsored by the Institute of Medicine.

The IOM panel recommended that Congress establish a single lead agency to oversee and manage emergency care, pulling together resources that are now currently overseen by an array of departments within various agencies, including the Department of Health and Human Services, the Department of Homeland Security, and the Department of Transportation.

As the committee envisioned it, that new lead agency would have planning and budgetary authority over the majority of emergency care activities at the federal level. Such an agency could raise the visibility of emergency medicine and emphasize the need to fund it. The agency would also coordinate how those federal dollars are spent.

Among other recommendations, the panel urged Congress to fund a demonstration program, to the tune of $88 million a year for 5 years, to assess strategies to coordinate and streamline the emergency care system. Federal agencies also need to support the development of national standards for measuring performance, the IOM said.

The report documents a host of issues besetting the emergency care system, including crowding, boarding, and diversions.

“The signs of distress are unmistakable,” said Dr. Arthur Kellermann, an IOM committee member and professor of emergency medicine at Emory University in Atlanta.

Over the past decade, visits to the emergency department—now up to about 114 million a year—have risen twice as fast as population growth. During the same period, the number of EDs shrank by 425, and the number of inpatient hospital beds fell by nearly 200,000.

“Do the math—with more people needing care and few resources available to provide that care, crowding in the ED was inevitable,” Dr. Kellermann said.

And with fewer hospital beds available, more severely ill and injured patients are boarded in the emergency department's exam rooms or even hallways until an inpatient bed can be made available.

“Some of them wait for hours, others wait for days. Meanwhile, other emergency patients are arriving every hour,” he said.

Often, EDs have no alternative but to divert inbound ambulances to other facilities. “When I started in my career, this was considered a rare and disturbing event,” Dr. Kellermann said. “It now happens more than half a million times a year in the United States.”

Demand Outpaces Resources

Emergency department responsibilities have grown over the years, with many now being expected to provide primary care to the uninsured, diagnostic services at night or on the weekend, and behavioral health care to the community.

Meanwhile, revenue has not kept pace. Medicare and Medicaid pay below cost for many emergency services, and uncompensated care has risen.

The emergency department is considered such an important public good that it is the only medical service that all Americans have a legal right to access. But hospitals are expected to finance that care through the free market system, Carmela Coyle, senior vice president for policy at the American Hospital Association, said during a briefing the day before release of the IOM report.

And because of low, and sometimes no, reimbursement, hospitals are finding it increasingly difficult to convince specialists to agree to be on call to the emergency department. Liability, especially in a setting where many uninsured patients are in poor health, is also a major concern for specialists, according to an AHA survey.

“It's tough to get called two, three o'clock in the morning to come in for a case where you know you might not get paid and you might get sued,” Ms. Coyle said.

Some hospitals have begun to pay specialists a retainer to be on-call, but that is just another financial burden making emergency departments a money-losing proposition, she said.

Stress on the System

Such financial difficulties have led to the closing of scores of emergency departments, which places more pressure on the remaining facilities.

Hospitals aren't inclined to give up inpatient beds to admit patients from the emergency department, who may pay at Medicaid rates or not at all, Dr. Kellermann said.

“Right now, all the incentives are to leave the patient in the ED so that they can keep admitting electives. You are financially penalized for making the right decision for patient care, because it is the wrong decision for your business,” he said.

The IOM committee also concluded that the emergency care system is not equipped to cope with a large-scale emergency.

“You've got to ask yourself, 'If our emergency departments are struggling to handle their daily and nightly load of 911 calls, how in the world are they going to handle a mass casualty event following a terrorist strike, an outbreak of infectious disease, or a natural disaster?” Dr. Kellermann said.

Federal funding for emergency preparedness has been and remains inadequate, the committee found. In 2002 and 2003, emergency care providers received 4% of $3.38 billion in first-responder funding distributed by the Department of Homeland Security—although emergency medical services personnel make up one-third of first responders. That has left EMS providers with scant training or planning to deal with a disaster situation.

Time to Act

The committee's findings show that emergency departments cannot continue to operate without more financial support, said Dr. Rick Blum, president of the American College of Emergency Physicians.

“Hospitals must be reimbursed for the significant amounts of uncompensated emergency and trauma care they provide,” he said in a statement.

Dr. Blum called for Congress to hold hearings on the state of emergency medicine and to pass the Access to Emergency Medical Services Act, introduced in the House last September and in the Senate in May 2006. The legislation targets several problems addressed in the report, including boarding, the lack of on-call specialists, and poor reimbursement for emergency care services.

Although emergency care on the whole is deeply troubled, the IOM committee found that there are islands of excellence—a select few facilities that have developed innovative approaches to dealing with the problems that all emergency departments face. Those islands provide a starting point on which to build a better system, committee members said.

“Our goal should be for these islands to coalesce and eventually blanket the United States with an emergency care system that has no holes,” Dr. Eastman said.

The panel envisioned a new regionalized system to coordinate care, so that patients are only taken to facilities that are appropriate and prepared to care for them, he said.

“Where there is no vision, the people perish,” Dr. Kellermann said. “Our committee has described a vision for a coordinated, regionalized, and accountable emergency care system. It's time to act.”

Gaps Noted in EMS, Pediatric Services

Problems with the state of hospital-based emergency care received the most focus in the release of the Institute of Medicine reports, but two accompanying reports highlight systemic issues with emergency medical services and pediatric emergency care.

Ambulance and other emergency medical services suffer from fragmentation that has led to critical problems in efficiency, efficacy, and coordination, according to the committee's report on emergency medical services.

The system is severely lacking in data to drive, or even gauge, performance. What few data do exist point to wide variations between communities, said committee member Shirley Gamble, chief operating officer for United Way Capital Area of Austin, Tex.

“There is as much as a 10-fold difference by community in survival rates for sudden cardiac arrest,” she said.

The committee also found that the patchwork nature of emergency medical services creates barriers to communication among emergency medical service providers and between those providers and emergency departments.

Children represent 27% of the country's 110 million emergency visits, but they often inappropriately receive adult-sized care, according to a committee report on emergency care for children.

“Many hospitals and EMS agencies may lack smaller-size medical equipment that is needed to care for these patients, and many providers receive limited training in pediatric emergency care,” said Dr. Marianne Gausche-Hill, director of prehospital care at Harbor-UCLA Medical Center in Torrance, Calif. Also, many medications used in the emergency department are given to children off-label, Dr. Gausche-Hill said, because they have not been approved by the Food and Drug Administration for pediatric use.

BALTIMORE — Personal health records may be the next step in the evolution of health information technology, but these electronic documents raise several legal and security issues for long-term care facilities.

“PHRs might in fact have the opportunity to leapfrog over things that are happening in electronic health records,” Dr. Steven Labkoff, director of business technology for Pfizer Inc., said at a meeting on long-term care health information technology.

The main difference between personal health records (PHRs) and electronic health records is who owns them. Ideally, patients should own their PHRs. But it is still unclear who should control what information is entered in the document and, perhaps more important, who should be able to delete information from the record, experts said at the meeting, sponsored by the American Health Information Management Association (AHIMA).

An online public survey conducted in 2003 found that 71% of respondents believed that personal health records would improve the quality of health care, said Jill Burrington-Brown, the practice manager for health information management products and services at AHIMA.

“The time is now to accelerate the development of personal health records,” she said, citing a report from Connecting for Health, a project of the Markle Foundation to promote the adoption and use of personal health records.

“A second finding was that PHRs are a means to necessary ends, such as increased consumer health awareness, activation, safety, and self-efficacy,” she said.

During roundtable discussions, meeting attendees said that they thought personal health records are a potentially important component of health information technology efforts, but many also had misgivings about the security risk represented by giving seniors, some with cognitive deficits, electronic access to their health records.

“Every day is a day that we work on security to make sure it is tight and concise,” said Daniel Wilt, director of information technology for Erickson Retirement Communities.

Erickson has launched a pilot program that allows residents to remotely access laboratory results, physician notes, and medical histories. The system also allows them to set appointments and keep health journals.

“They want their labs. That's the one thing they really want. They go to the medical center, they run back upstairs, they go to their computers, and they ask 'It's been 20 minutes; where are my labs?' We have to explain it takes 24 hours,” he said.

While most users really like the system, administrators have had to struggle with how much access the public should have. For example, Mr. Wilt said, should administrators allow adult children to look at records or let residents change information that they deem incorrect?

By definition, personal health records need to be individually owned, said Ms. Burrington-Brown.

“The individuals own the PHR in a similar way as we own money in the bank. There is some conversation in the industry about who really owns that, because of who produces it. That is a conversation that is going to be going on” for quite some time, she said.

Industry groups are working on a standard format for personal health records, while groups such as the American Health Information Community and the National Committee on Vital and Health Statistics are developing standards to ensure interoperability and security of those documents.

“We have a lot of PHR activities occurring at many levels,” she said.

BALTIMORE — Personal health records may be the next step in the evolution of health information technology, but these electronic documents raise several legal and security issues for long-term care facilities.

“PHRs might in fact have the opportunity to leapfrog over things that are happening in electronic health records,” Dr. Steven Labkoff, director of business technology for Pfizer Inc., said at a meeting on long-term care health information technology.

The main difference between personal health records (PHRs) and electronic health records is who owns them. Ideally, patients should own their PHRs. But it is still unclear who should control what information is entered in the document and, perhaps more important, who should be able to delete information from the record, experts said at the meeting, sponsored by the American Health Information Management Association (AHIMA).

An online public survey conducted in 2003 found that 71% of respondents believed that personal health records would improve the quality of health care, said Jill Burrington-Brown, the practice manager for health information management products and services at AHIMA.

“The time is now to accelerate the development of personal health records,” she said, citing a report from Connecting for Health, a project of the Markle Foundation to promote the adoption and use of personal health records.

“A second finding was that PHRs are a means to necessary ends, such as increased consumer health awareness, activation, safety, and self-efficacy,” she said.

During roundtable discussions, meeting attendees said that they thought personal health records are a potentially important component of health information technology efforts, but many also had misgivings about the security risk represented by giving seniors, some with cognitive deficits, electronic access to their health records.

“Every day is a day that we work on security to make sure it is tight and concise,” said Daniel Wilt, director of information technology for Erickson Retirement Communities.

Erickson has launched a pilot program that allows residents to remotely access laboratory results, physician notes, and medical histories. The system also allows them to set appointments and keep health journals.

“They want their labs. That's the one thing they really want. They go to the medical center, they run back upstairs, they go to their computers, and they ask 'It's been 20 minutes; where are my labs?' We have to explain it takes 24 hours,” he said.

While most users really like the system, administrators have had to struggle with how much access the public should have. For example, Mr. Wilt said, should administrators allow adult children to look at records or let residents change information that they deem incorrect?

By definition, personal health records need to be individually owned, said Ms. Burrington-Brown.

“The individuals own the PHR in a similar way as we own money in the bank. There is some conversation in the industry about who really owns that, because of who produces it. That is a conversation that is going to be going on” for quite some time, she said.

Industry groups are working on a standard format for personal health records, while groups such as the American Health Information Community and the National Committee on Vital and Health Statistics are developing standards to ensure interoperability and security of those documents.

“We have a lot of PHR activities occurring at many levels,” she said.

BALTIMORE — Personal health records may be the next step in the evolution of health information technology, but these electronic documents raise several legal and security issues for long-term care facilities.

“PHRs might in fact have the opportunity to leapfrog over things that are happening in electronic health records,” Dr. Steven Labkoff, director of business technology for Pfizer Inc., said at a meeting on long-term care health information technology.

The main difference between personal health records (PHRs) and electronic health records is who owns them. Ideally, patients should own their PHRs. But it is still unclear who should control what information is entered in the document and, perhaps more important, who should be able to delete information from the record, experts said at the meeting, sponsored by the American Health Information Management Association (AHIMA).

An online public survey conducted in 2003 found that 71% of respondents believed that personal health records would improve the quality of health care, said Jill Burrington-Brown, the practice manager for health information management products and services at AHIMA.

“The time is now to accelerate the development of personal health records,” she said, citing a report from Connecting for Health, a project of the Markle Foundation to promote the adoption and use of personal health records.

“A second finding was that PHRs are a means to necessary ends, such as increased consumer health awareness, activation, safety, and self-efficacy,” she said.

During roundtable discussions, meeting attendees said that they thought personal health records are a potentially important component of health information technology efforts, but many also had misgivings about the security risk represented by giving seniors, some with cognitive deficits, electronic access to their health records.

“Every day is a day that we work on security to make sure it is tight and concise,” said Daniel Wilt, director of information technology for Erickson Retirement Communities.

Erickson has launched a pilot program that allows residents to remotely access laboratory results, physician notes, and medical histories. The system also allows them to set appointments and keep health journals.

“They want their labs. That's the one thing they really want. They go to the medical center, they run back upstairs, they go to their computers, and they ask 'It's been 20 minutes; where are my labs?' We have to explain it takes 24 hours,” he said.

While most users really like the system, administrators have had to struggle with how much access the public should have. For example, Mr. Wilt said, should administrators allow adult children to look at records or let residents change information that they deem incorrect?

By definition, personal health records need to be individually owned, said Ms. Burrington-Brown.

“The individuals own the PHR in a similar way as we own money in the bank. There is some conversation in the industry about who really owns that, because of who produces it. That is a conversation that is going to be going on” for quite some time, she said.

Industry groups are working on a standard format for personal health records, while groups such as the American Health Information Community and the National Committee on Vital and Health Statistics are developing standards to ensure interoperability and security of those documents.

“We have a lot of PHR activities occurring at many levels,” she said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc. in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said. On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools. The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs. There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc. in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said. On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools. The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs. There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc. in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said. On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools. The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs. There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges has warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

There are 126 U.S. medical schools graduating about 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC. Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, fewer than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce.

“Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools.

And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots. “It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges has warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

There are 126 U.S. medical schools graduating about 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC. Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, fewer than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce.

“Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools.

And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots. “It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges has warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

There are 126 U.S. medical schools graduating about 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC. Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, fewer than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce.

“Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools.

And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots. “It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine in Tallahassee, which was accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach of Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, who is president of the Florida Medical Association.

“The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce.

“Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine in Tallahassee, which was accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach of Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, who is president of the Florida Medical Association.

“The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce.

“Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine in Tallahassee, which was accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach of Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, who is president of the Florida Medical Association.

“The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce.

“Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see shortages as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned. The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

There are now 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC. Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said. On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, Mr. Umbach agreed. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see shortages as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned. The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

There are now 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC. Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said. On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, Mr. Umbach agreed. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see shortages as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned. The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

There are now 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC. Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said. On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit from the schools. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, Mr. Umbach agreed. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

Several states are in the process of adding new medical schools to shore up expected shortfalls in the physician workforce.

The United States could see physician shortages run as high as 85,000 physicians by 2020, according to government estimates. States will have to start expanding medical school enrollment now to avoid shortages down the road, the Association of American Medical Colleges recently warned.

The response from the states is to train more physicians.

Florida State University's College of Medicine, accredited just last year, became the first new allopathic medical school in more than 20 years. Together with expansion of existing schools, Florida's medical schools will more than double enrollment, up to 1,100 students.

Evidently not satisfied with that increase, the board of governors of the state university system recently approved proposals to set up two more medical schools, one at Florida International University and the other at the University of Central Florida. Those medical schools could be up and enrolling by 2008.

Other states are also considering new medical schools as a way to bring physicians into their communities. The University of California at Merced, barely out of the box itself, presented a proposal this month to set up a medical school by 2012.

California currently has to recruit physicians from out of state because of a gap between the number of doctors trained in the state and the number needed, said Peter Warren, a spokesman for the California Medical Association.

It wouldn't be surprising to see five or six new medicals schools start up across the country over the next 5 years, said Paul Umbach, a principal with Tripp Umbach Healthcare Consulting Inc., in Pittsburgh.

Currently, there are 126 U.S. medical schools graduating a few more than 15,000 students a year, said Jack Krakower, Ph.D., associate vice president of medical school services and studies at AAMC.

Along with graduates from international medical and osteopathic schools, they fill roughly 22,000 residency slots, virtually all of which are currently funded through the Medicare program.

More medical schools will not equal more doctors unless there are also more residency slots for those graduates. Even then, there are no guarantees that physicians trained in a state will stay in the state, Dr. Krakower said.

On average, less than 40% of medical students remain in state after graduation. That number rises to 48% among students who get a residency position in the state and gets as high as 65% for those who started out in the state, according to AAMC data.

Whether physicians end up sticking around, Florida and other states may see benefit in building new schools.

The board of governors was heavily lobbied for the medical schools by local businesses, mostly real estate and construction companies. These interests will be the most immediate beneficiaries of the funds raised to build the new schools, said Dr. Zachariah P. Zachariah, a board member who questioned the wisdom of this approach.

There is little question that local business will benefit. An economic impact study conducted by Mr. Umbach's firm for Florida International University showed that a new medical school could pour more than a $1 billion a year into the local economy and create 8,300 new jobs.

There are better ways to boost Florida's physician workforce, said Troy Tippett, president of the Florida Medical Association. “The quickest, most efficient way is to add residency slots,” he said.

The economics of medical schools are very attractive to communities, agreed Mr. Umbach. But they also bring in faculty who provide care to the community, producing a short-term boost to the medical workforce. “Just banking alone on medical students staying in the state would be a very slow way to build the physician workforce,” he said. “But communities with medical schools have more physicians than those without medical schools.”

That argument seems to be winning. The FMA didn't oppose the proposal for new medical schools. And despite his concerns, Dr. Zachariah voted in favor of the measure based on assurances from county officials that they would also expand existing medical programs and add state-funded residency slots.

“It's a fair compromise,” he said.

WASHINGTON — Health care reform would be nice. That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told the audience of politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

“If our health care system doesn't work for doctors, it doesn't work,” said Sen. Hillary Clinton (D-N.Y.). She drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate (SGR) formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers. “Most of us don't want to go through this annual ritual,” said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors shouldn't expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the SGR over a 2-year period and increase physician reimbursement 5% a year in the interim.

Lawmakers from both parties said physicians need relief from skyrocketing medical liability premiums in many states.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

“Caps don't get to the heart of the problem,” said Sen. Clinton. Instead, Congress needs to bridge the gap between medical liability reform and error-reporting legislation. She cited the University of Michigan's “Sorry Works!” initiative—a program that encourages doctors and their insurers to be honest when mistakes happen, offer apologies, and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans demonstrated a similar divide on the uninsured. Rep. Markey said the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured. Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care.

WASHINGTON — Health care reform would be nice. That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told the audience of politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

“If our health care system doesn't work for doctors, it doesn't work,” said Sen. Hillary Clinton (D-N.Y.). She drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate (SGR) formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers. “Most of us don't want to go through this annual ritual,” said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors shouldn't expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the SGR over a 2-year period and increase physician reimbursement 5% a year in the interim.

Lawmakers from both parties said physicians need relief from skyrocketing medical liability premiums in many states.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

“Caps don't get to the heart of the problem,” said Sen. Clinton. Instead, Congress needs to bridge the gap between medical liability reform and error-reporting legislation. She cited the University of Michigan's “Sorry Works!” initiative—a program that encourages doctors and their insurers to be honest when mistakes happen, offer apologies, and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans demonstrated a similar divide on the uninsured. Rep. Markey said the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured. Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care.

WASHINGTON — Health care reform would be nice. That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told the audience of politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

“If our health care system doesn't work for doctors, it doesn't work,” said Sen. Hillary Clinton (D-N.Y.). She drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate (SGR) formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers. “Most of us don't want to go through this annual ritual,” said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors shouldn't expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the SGR over a 2-year period and increase physician reimbursement 5% a year in the interim.

Lawmakers from both parties said physicians need relief from skyrocketing medical liability premiums in many states.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

“Caps don't get to the heart of the problem,” said Sen. Clinton. Instead, Congress needs to bridge the gap between medical liability reform and error-reporting legislation. She cited the University of Michigan's “Sorry Works!” initiative—a program that encourages doctors and their insurers to be honest when mistakes happen, offer apologies, and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans demonstrated a similar divide on the uninsured. Rep. Markey said the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured. Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care.

WASHINGTON — Wouldn't reform be nice? That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told the audience of politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

“If our health care system doesn't work for doctors, it doesn't work,” said Sen. Hillary Clinton (D-N.Y.).

“It's fair to say that the AMA and I did not see to eye to eye,” said Sen. Clinton, referring to her failed health care reform proposal when she was First Lady. “But it is 12 years later, and we have many of the same problems.”

Sen. Clinton may not have been speaking to the friendliest audience, but she drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers.

“Most of us don't want to go through this annual ritual,” said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors should not expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the sustainable growth rate over a 2-year period and increase physician reimbursement 5% a year in the interim.

Lawmakers from both parties also noted that physicians need relief from skyrocketing medical liability premiums in many states.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

“Caps don't get to the heart of the problem,” said Sen. Clinton. Instead, Congress needs to bridge the gap between medical liability reform and error-reporting legislation.

She cited the University of Michigan's “Sorry Works!” initiative—a program that encourages doctors and their insurers to be honest when mistakes happen, offer apologies, and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans showed a similar divide on the uninsured.

Rep. Markey said that the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured.

Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care from private entities.

The Democrats said that the government should spend more money on prevention and research, which has the potential to lower costs over the long run. Republicans said that what is needed is a marketplace that allows individuals to “own” their coverage while making them more aware of the cost of health care.

WASHINGTON — Wouldn't reform be nice? That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told the audience of politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

“If our health care system doesn't work for doctors, it doesn't work,” said Sen. Hillary Clinton (D-N.Y.).

“It's fair to say that the AMA and I did not see to eye to eye,” said Sen. Clinton, referring to her failed health care reform proposal when she was First Lady. “But it is 12 years later, and we have many of the same problems.”

Sen. Clinton may not have been speaking to the friendliest audience, but she drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers.

“Most of us don't want to go through this annual ritual,” said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors should not expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the sustainable growth rate over a 2-year period and increase physician reimbursement 5% a year in the interim.

Lawmakers from both parties also noted that physicians need relief from skyrocketing medical liability premiums in many states.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

“Caps don't get to the heart of the problem,” said Sen. Clinton. Instead, Congress needs to bridge the gap between medical liability reform and error-reporting legislation.

She cited the University of Michigan's “Sorry Works!” initiative—a program that encourages doctors and their insurers to be honest when mistakes happen, offer apologies, and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans showed a similar divide on the uninsured.

Rep. Markey said that the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured.

Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care from private entities.

The Democrats said that the government should spend more money on prevention and research, which has the potential to lower costs over the long run. Republicans said that what is needed is a marketplace that allows individuals to “own” their coverage while making them more aware of the cost of health care.

WASHINGTON — Wouldn't reform be nice? That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told the audience of politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

“If our health care system doesn't work for doctors, it doesn't work,” said Sen. Hillary Clinton (D-N.Y.).

“It's fair to say that the AMA and I did not see to eye to eye,” said Sen. Clinton, referring to her failed health care reform proposal when she was First Lady. “But it is 12 years later, and we have many of the same problems.”

Sen. Clinton may not have been speaking to the friendliest audience, but she drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers.

“Most of us don't want to go through this annual ritual,” said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors should not expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the sustainable growth rate over a 2-year period and increase physician reimbursement 5% a year in the interim.

Lawmakers from both parties also noted that physicians need relief from skyrocketing medical liability premiums in many states.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

“Caps don't get to the heart of the problem,” said Sen. Clinton. Instead, Congress needs to bridge the gap between medical liability reform and error-reporting legislation.

She cited the University of Michigan's “Sorry Works!” initiative—a program that encourages doctors and their insurers to be honest when mistakes happen, offer apologies, and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans showed a similar divide on the uninsured.

Rep. Markey said that the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured.

Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care from private entities.

The Democrats said that the government should spend more money on prevention and research, which has the potential to lower costs over the long run. Republicans said that what is needed is a marketplace that allows individuals to “own” their coverage while making them more aware of the cost of health care.

WASHINGTON – Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price (R-Ga.), also an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions. “I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

While the uninsured has been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of it's considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the uninsured problem has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, said attendees.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, said Dr. Anderson. That perspective may not win over politicians, advised Dr. Price.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year.

“The remarkable partisanship in which we currently find ourselves is absolutely stifling,” he said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci, D-Maine, said at the meeting. The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody. … If they were going to buy into it, they needed to have some ownership in the process itself,” said Gov. Baldacci.

Physicians need to play a more central role in reforming the health care system to provide access to more people, said Dr. Lewin. “Either we just sit and wait for a single payer system, or we propose something better,” he warned.

WASHINGTON – Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price (R-Ga.), also an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions. “I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

While the uninsured has been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of it's considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the uninsured problem has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, said attendees.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, said Dr. Anderson. That perspective may not win over politicians, advised Dr. Price.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year.

“The remarkable partisanship in which we currently find ourselves is absolutely stifling,” he said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci, D-Maine, said at the meeting. The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody. … If they were going to buy into it, they needed to have some ownership in the process itself,” said Gov. Baldacci.

Physicians need to play a more central role in reforming the health care system to provide access to more people, said Dr. Lewin. “Either we just sit and wait for a single payer system, or we propose something better,” he warned.

WASHINGTON – Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price (R-Ga.), also an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions. “I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

While the uninsured has been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of it's considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the uninsured problem has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, said attendees.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, said Dr. Anderson. That perspective may not win over politicians, advised Dr. Price.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year.

“The remarkable partisanship in which we currently find ourselves is absolutely stifling,” he said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci, D-Maine, said at the meeting. The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody. … If they were going to buy into it, they needed to have some ownership in the process itself,” said Gov. Baldacci.

Physicians need to play a more central role in reforming the health care system to provide access to more people, said Dr. Lewin. “Either we just sit and wait for a single payer system, or we propose something better,” he warned.