Graduate Medical education

Graduate and indirect Medical Education

Since the creation of the Medicare and Medicaid programs in 1965, the public has provided tens of billions of dollars to fund graduate medical education (GME), the period of residency and fellowship that is provided to physicians after they receive a medical degree. Although the scale of govern­ment support for physician training far exceeds that for any other profession, there is a striking absence of transparency and accountability in the GME financing system for producing the types of physicians that the nation needs.

According to the report, GME is publicly supported through Medicare ($9.7 billion in 2012) and Medicaid ($3.9 billion), but there is no guarantee that a physician will serve Medicare or Medicaid patients once through his or her residency. Further, they found that GME programs are funded without any way of knowing if the funds are being used to address local, national or regional health needs, and that being accredited is only criteria used to determine accountability.

The IOM committee also found fault with current GME payment methods. Calling the methods “outdated, ” because they are based on a time when the central site for physician training was the teaching hospital. This “discourages physician training outside the hospital, in clinical settings where most healthcare is delivered, ” according to the report. The report also cites that the GME payment method is linked to the hospital’s Medicare inpatient volume, so children’s hospitals, safety-net hospitals and other facilities that don’t care for a high proportion of elderly people are at disadvantage, and “Non-clinical, population-based specialties, such as public health and preventative medicine, are similarly affected.”

Recommendation 1: Maintain Medicare graduate medical education (GME) support at the current aggregate amount (i.e., the total of indirect medical education and direct graduate medical education expenditures in an agreed-on base year, adjusted annually for inflation) while taking essential steps to modernize GME payment methods based on performance, to ensure program oversight and accountability, and to incentivize innovation in the content and financing of GME. The current Medicare GME payment system should be phased out.

Recommendation 2: Build a graduate medical education (GME) policy and financing infrastructure.

2a. Create a GME Policy Council in the Office of the Secretary of the U.S. Department of Health and Human Services. Council members should be appointed by the Secretary and provided with sufficient funding, staff, and technical resources to fulfill the responsibilities listed below.

  • Development and oversight of a strategic plan for Medicare GME financing;
  • Research and policy development regarding the sufficiency, geographic distribution, and specialty configuration of the physician workforce;
  • Development of future federal policies concerning the distribution and use of Medicare GME funds;
  • Convening, coordinating, and promoting collaboration between and among federal agencies and private accreditation and certification organizations; and
  • Provision of annual progress reports to Congress and the Executive Branch on the state of GME.

Needed: More Doctors in America  — New York Times
The A.M.A. has fought diligently over the years to mitigate physician shortages on a number of fronts, including efforts to expand funding for graduate medical education and to advocate for more residency slots to train physicians in needed specialties ..

Opinion: Right On, IOM -- Reform Needed in GME  — MedPage Today
.. slamming U.S. medical educators for failing to meet minimal training standards for new physicians, which recommended a major overhaul of government funding for graduate medical education. In addition, NEJM published Perspectives pieces on the topic.

Amer Medical Assn Graduate Medical Education Directory 2011-2012
Book (Amer Medical Assn)
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