D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 4 Issue 1 January 2015
A Journey of Discovery
Richard Obenour, MD, Vice Chair of the Department of Medicine (DOM), retired December 2014, finishing a career that started just after Watson and Crick unraveled the DNA double helix and followed the still accelerating trajectory of the information explosion in the medical sciences. After receiving his medical degree from the University of Tennessee, he completed an internship at the historic Knoxville General Hospital during its last year of existence. He started his residency in 1956 when the doors opened at the newly constructed University of Tennessee Memorial Research Hospital (UTMRH). He admitted the very first medical patient to the new facility, a man transferred from the old hospital in a hearse. Dr. Obenour’s training was interrupted when he was drafted into the Navy. After two years, he returned to Knoxville to finish his resident year before moving to Duke University to complete his internal medicine training and start a cardiovascular research fellowship. When the equipment needed to start his research project did not materialize, he accepted an opportunity to study the effects of altered surfactant on the mechanics of breathing. His career in pulmonary medicine was born. In 1962, he came home to practice as the only nonsurgical lung specialist in this region. After six years of solo practice, he brought in his first associate, and over time, the practice grew into the Knoxville Pulmonary Group, precursor to University Pulmonary and Critical Care. In 1973, he became the first pulmonary division chief at UTMH, a post he held until 2004. In 1992, Dr. Al Beasley, then Chair of the DOM asked him to
Points of View At a recent meeting with the residents, I was somewhat surprised to learn that they were not aware of how the federal government funds graduate medical education (GME). The federal government provides nearly 16 billion dollars (called GME dollars) annually to support the education of over 115,000 residents Rajiv Dhand, MD, Chair and fellows in the US. Medicare, the largest federal contributor, provides 3 billion dollars for direct medical education (DME) to support resident salaries, benefits, and faculty time. This support is tied to the percentage of care provided to Medicare
Dr. Obenour pictured with his original spirometer
be his Vice Chief. One of his several accomplishments in that role included the establishment of the Quality Assurance Program. Dr. Obenour recognized early the need for interdepartmental communication and incorporated other departments into the process to study outcomes that are now benchmarks of treatment for pneumonia and other illnesses. He also developed a physician credentialing system that with some modifications is in general continued on page 2
beneficiaries. The indirect medical education (IME) funds, almost 6.5 billion dollars annually, subsidize hospitals for the higher costs of care to run training programs and the severity of illness of patients requiring specialized services that are available only in teaching hospitals. Additional contributions to fund GME are made from federal Medicaid, Veterans Health Administration and the state’s support through Medicaid spending. In 1997, as part of the Balanced Budget Act, the Federal Government “capped” the number of residency positions that would be supported by Medicare and reduced DME payments by $1 billion and IME payments by $8 billion over a period of 5 years. Further growth in the number of residency positions occurred by institutions’ covering the cost of training residents at each center. On April 1, 2013, the budget sequestration went into effect, continued on page 3
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