The AAOS attempted to explain itself, in a letter sent to Senator Kohl (D-WI), a sponsor of the Sunshine Act, maintaining that its actions against Dr. Rosen had not been made in retaliation for his testimony in support of the act. (That was important for them to establish because, as the Senator warned the organization, retaliation over Rosen's testimony would have constituted a federal crime.) Despite protestations that its motivations were pure, the AAOS did not deny that it knowingly allowed a surgeon on probation to file the grievance. * * * * * *
While Dr. Rosen's efforts are intended to promote awareness of problems like industry-financed medical training, there is one organization, according to a senior Medicare director (who asked to remain anonymous), that could actually change the system. The Accreditation Council for Graduate Medical Education (ACGME), the official explains, could bar outside funding sources for training programs today if it chose to do so.
Unfortunately, however, beyond a vague 2002 position paper stating that medical educators should manage industry relationships in ways that promote professionalism and medical ethics, the ACGME so far has had little to say on the matter. Dr. Thomas Nasca, the ACGME's CEO, declined interview requests and would only say, through his spokesperson, "we are not involved in the funding decisions for residency and fellowship programs."
For now, then, it seems that industry funded training is here to stay, as there is no authority willing to take action against it. Unless Congress steps in, Medicare can't even prohibit double-dipping (a practice whereby institutions take in both federal and industry money for the same fellowship). That means that the nation's hospitals and clinics are left to make difficult choices while trying to survive in a strained economy.
Not everyone, however, is giving in to temptation. Over the past few years, the University of Wisconsin has taken a close look at all of its industry connections and put in place tough internal policies that treat any new links with extreme caution.
Like many major teaching institutions, Wisconsin spends far more on its residents and fellows than Medicare reimburses, but it picks up the slack on its own, resolutely finding ways to raise money itself, rather than resorting to industry funds. As times have gotten tighter, its orthopedics department has sometimes eyed other institutions enjoying their industry provided wealth.
But "at this point," says Dr. Carl Getto, Senior Vice President for Medical Affairs at UW Hospitals and Clinics, "we've chosen not to do that." And so, for the moment at least, they're sticking to their ideals.