Journal of the American College of Radiology : JACR
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The education of radiology residents and fellows is a vitally important but costly process. This paper reviews the most common methods of funding graduate medical education. The majority of graduate medical education in the United States is funded by Medicare, but there are caps on the number of trainees allowed, and the government is cutting payments. Academic medicine, particularly academic radiology, is at a point of crisis today if new methods to provide additional support are not found.
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Innovations in the field of radiology have been and continue to be possible through research that includes patients or healthy volunteers, or both, as research subjects. This article describes the principles that guide the ethical conduct of research as well as the procedures by which those principles are implemented, with a focus on how the principles are relevant to human research in radiology. ⋯ These include distinguishing research endeavors from innovative treatment, determining the acceptability of randomization and placebos, compensating for the "therapeutic misconception" of research subjects, and deciding when to disclose test results and incidental findings from research to subjects. We offer suggestions for anticipating and resolving such issues.
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This paper, the last of 3 that discuss the reimbursement challenges facing new medical device technology in various issues of this journal, addresses the structural diversity of Medicare's various payment systems. These systems vary widely in how they establish prices, how they incorporate new technologies and procedures, and the means by which they are updated and maintained. ⋯ It is important to recognize that coverage can be undermined without adequate payment and that this situation will dampen further product innovation. The 3 papers, taken together, document the challenges posed by insurer reimbursement policies and show that a close working relationship between the manufacturers that develop new medical technologies and physician practitioners is needed if reimbursement hurdles are to be managed and medical innovation is to continue.