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===Graduate medical education=== Medicare funds the vast majority of [[Residency (medicine)|residency]] training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education payments. Medicare also uses taxes for Indirect Medical Education, a subsidy paid to [[teaching hospital]]s in exchange for training resident physicians.<ref>{{cite journal |last=Gottlieb |first=Scott |date=November 1997 |title=Medicare funding for medical education: a waste of money? |journal=[[USA Today (magazine)|USA Today]]}} [http://findarticles.com/p/articles/mi_m1272/is_n2630_v126/ai_20004039 Reprint] by [[BNET]]. {{Webarchive|url=https://web.archive.org/web/20080927212732/http://findarticles.com/p/articles/mi_m1272/is_n2630_v126/ai_20004039|date=September 27, 2008}}.</ref> For the 2008 fiscal year these payments were $2.7 billion and $5.7 billion, respectively.<ref>{{cite journal |url=http://www.aamc.org/newsroom/reporter/feb09/payments.htm |title=Overview: Medicare Direct Graduate and Indirect Medical Education Payments |last=Fuchs |first=Elissa |date=February 2009 |journal=AAMC Reporter |issn=1544-0540 |access-date=November 12, 2009 |archive-url=https://web.archive.org/web/20100613150629/http://aamc.org/newsroom/reporter/feb09/payments.htm |archive-date=June 13, 2010 |url-status=dead }}</ref> Overall funding levels have remained at the same level since 1996, so that the same number or fewer residents have been trained under this program.<ref name="amednews2006-01-30">{{cite news |url=http://www.ama-assn.org/amednews/2006/01/30/prl20130.htm |title=Innovative funding opens new residency slots |last=Croasdale |first=Myrle |date=January 30, 2006 |newspaper=American Medical News |publisher=[[American Medical Association]] }}</ref> Meanwhile, the US population continues to grow both older and larger, which has led to greater demand for physicians, in part due to higher rates of illness and disease among the elderly compared to younger individuals. At the same time the cost of medical services continue rising rapidly and many geographic areas face physician shortages, both trends suggesting the supply of physicians remains too low.<ref>{{cite journal |title=Shortages of Medical Personnel at Community Health Centers |journal=Journal of the American Medical Association |date=March 1, 2006 |volume=295 |issue=9 |first1=Roger A. |last1=Rosenblatt |first2=C. Holly A. |last2=Andrilla |first3=Thomas |last3=Curtin |first4=L. Gary |last4=Hart |pages=1042β49 |pmid=16507805 |doi=10.1001/jama.295.9.1042 |doi-access=free }}</ref> Medicare thus finds itself in the odd position of having assumed control of the single largest funding source for graduate medical education, currently facing major budget constraints, and as a result, freezing funding for graduate medical education, as well as for physician reimbursement rates. This has forced hospitals to look for alternative sources of funding for residency slots.<ref name=amednews2006-01-30/> This halt in funding in turn exacerbates the exact problem Medicare sought to solve in the first place: improving the availability of medical care. However, some healthcare administration experts believe that the shortage of physicians may be an opportunity for providers to reorganize their delivery systems to become less costly and more efficient. Physician assistants and Advanced Registered Nurse Practitioners may begin assuming more responsibilities that traditionally fell to doctors, but do not necessarily require the advanced training and skill of a physician.<ref>{{cite journal |last=Rovner |first=Julie |date=August 2012 |title=Prognosis Worsens For Shortages In Primary Care |journal=[[Talk of the Nation]]}}. [https://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care] by [[NPR]].</ref>
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