programs. J Hum Resources. 1978;13:211-245. 3. Hadley J. Physician participation in Medicaid: evidence from California. Health
Serv Res. 1979;14:265-280.
In Reply.\p=m-\Thedata from Dr Fox and Mr Phua are of interest because they reflect the effects of actual increases in Medicaid payments on obstetricians' participation in Medicaid. Although the increase in payments stemmed declining participation rates, they found, as we did, that the overall effect of increased payments on participation was modest. The second North Carolina Pediatric Society survey points up how different approaches to measuring participation in Medicaid may yield different results. This survey differed somewhat from ours in that it was sent only to pediatricians who were members of the pediatric society, a different definition was used to determine if pediatricians were in active practice, the findings regarding the relationship of Medicaid payments to participation were not controlled for other factors that may influence physicians' decisions to participate in Medicaid, and the survey asked what physicians would do in response to increased payments rather than assessing the relationship of actual payments to observed participation rates. In addition, the definition of Medicaid participation was different. We used the American Academy of Pediatrics' definition of restricted access to Medicaid patients. This def¬ inition classifies physicians who accept some Medicaid and some non-Medicaid patients as providing unrestricted access to Medicaid patients. It may be, however, that physicians who are accepting only some patients into their practice, still give preference to non-Medicaid patients. Thus, the American Academy of Pediatrics' definition may underestimate the magnitude of the problem of restricted access, as Drs Edwards and Brown imply. To date, no studies have mea¬ sured restricted access from the point of view of the family seeking care for their child, the most relevant perspective. The primary aim of our study was to delineate the range of factors that may influence pediatricians to accept children on Medicaid into their practice. There is no doubt that the impact of Medicaid payments on participation remains a very meaningful issue to many physicians. Thus, it is important that policymakers address the issue of Medicaid reimburse¬ ment. As the letter by Edwards and Brown indicates, without a more equitable payment system, it will be difficult to obtain the support of leaders in the medical community for other, more comprehensive initiatives to increase socially disadvantaged children's access to care in physicians' offices. How¬ ever, increasing physicians' participation in Medicaid will require not only increased reimbursement, but also efforts to address other factors, such as attitudes toward the economics of accepting Medicaid and the local norms of the medical
community.
Peter A. Margolis, MD, PhD Robert Cook, MD, PhD JoAnn Earp, ScD Carole Lannon, MD Lynette Keyes, MS University of North Carolina at
Integrity in the National
tention to rank our program first on their match list. Each year we are amazed at the manipulative behavior of some of our applicants. They often don't tell the truth. The intensely competitive nature of obtaining postgraduate training may be their justification. Like competing for employment in the business world, they will tell their prospective employer anything just to get the job! The fear and embarrassment of not "matching" is a compelling motivation. Part of our duty as physician educators is to be role models for students, exemplifying integrity, empathy, and the other qualities that have earned members of our profession a high level of respect in society. Where have we failed? Perhaps program directors overstate their intentions toward appli¬ cants or solicit praiseworthy comments. If so, we have set a bad example for students and have fostered this dishonesty. Or, have students been given poor instructions? The Handbook for Students published by the National Resident Matching Program reveals some interesting information: There is one cardinal rule that both programs and applicants must observe: neither must make a commitment before the match. It is perfectly acceptable for programs to express a high level of interest in applicants to recruit them into their program. It is perfectly ac¬ ceptable for applicants to say that they would prefer to enter one program over others. However, neither programs nor applicants should consider such expressions to be commitments. Candor and honesty should be observed... .1
Serv Res. 1979;14:265-280.
In Reply.\p=m-\Thedata from Dr Fox and Mr Phua are of interest because they reflect the effects of actual increases in Medicaid payments on obstetricians' participation in Medicaid. Although the increase in payments stemmed declining participation rates, they found, as we did, that the overall effect of increased payments on participation was modest. The second North Carolina Pediatric Society survey points up how different approaches to measuring participation in Medicaid may yield different results. This survey differed somewhat from ours in that it was sent only to pediatricians who were members of the pediatric society, a different definition was used to determine if pediatricians were in active practice, the findings regarding the relationship of Medicaid payments to participation were not controlled for other factors that may influence physicians' decisions to participate in Medicaid, and the survey asked what physicians would do in response to increased payments rather than assessing the relationship of actual payments to observed participation rates. In addition, the definition of Medicaid participation was different. We used the American Academy of Pediatrics' definition of restricted access to Medicaid patients. This def¬ inition classifies physicians who accept some Medicaid and some non-Medicaid patients as providing unrestricted access to Medicaid patients. It may be, however, that physicians who are accepting only some patients into their practice, still give preference to non-Medicaid patients. Thus, the American Academy of Pediatrics' definition may underestimate the magnitude of the problem of restricted access, as Drs Edwards and Brown imply. To date, no studies have mea¬ sured restricted access from the point of view of the family seeking care for their child, the most relevant perspective. The primary aim of our study was to delineate the range of factors that may influence pediatricians to accept children on Medicaid into their practice. There is no doubt that the impact of Medicaid payments on participation remains a very meaningful issue to many physicians. Thus, it is important that policymakers address the issue of Medicaid reimburse¬ ment. As the letter by Edwards and Brown indicates, without a more equitable payment system, it will be difficult to obtain the support of leaders in the medical community for other, more comprehensive initiatives to increase socially disadvantaged children's access to care in physicians' offices. How¬ ever, increasing physicians' participation in Medicaid will require not only increased reimbursement, but also efforts to address other factors, such as attitudes toward the economics of accepting Medicaid and the local norms of the medical
community.
Peter A. Margolis, MD, PhD Robert Cook, MD, PhD JoAnn Earp, ScD Carole Lannon, MD Lynette Keyes, MS University of North Carolina at
Integrity in the National
tention to rank our program first on their match list. Each year we are amazed at the manipulative behavior of some of our applicants. They often don't tell the truth. The intensely competitive nature of obtaining postgraduate training may be their justification. Like competing for employment in the business world, they will tell their prospective employer anything just to get the job! The fear and embarrassment of not "matching" is a compelling motivation. Part of our duty as physician educators is to be role models for students, exemplifying integrity, empathy, and the other qualities that have earned members of our profession a high level of respect in society. Where have we failed? Perhaps program directors overstate their intentions toward appli¬ cants or solicit praiseworthy comments. If so, we have set a bad example for students and have fostered this dishonesty. Or, have students been given poor instructions? The Handbook for Students published by the National Resident Matching Program reveals some interesting information: There is one cardinal rule that both programs and applicants must observe: neither must make a commitment before the match. It is perfectly acceptable for programs to express a high level of interest in applicants to recruit them into their program. It is perfectly ac¬ ceptable for applicants to say that they would prefer to enter one program over others. However, neither programs nor applicants should consider such expressions to be commitments. Candor and honesty should be observed... .1
