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Health Care Leaders: GME System Needs to Better Align with Patient Needs
New York, NY
GME Policy Workgroup Recommendations Would Reshape Current GME System To Make It More Accountable, Flexible and Responsive
A panel of leaders in academic medicine and health care today urged Congress to seek an independent, external review of how U.S. graduate medical education programs are governed, financed, and regulated to make sure that they are producing the right number and mix of physicians and that they are more accountable to public need. With the United States facing a serious shortage of physicians and increased numbers of patients with medical insurance seeking care, the group is calling for an immediate, one-time increase in the number of medical residency slots in targeted specialties so the United States can maintain a ratio of 250 doctors for every 100,000 people.
The recommendations are part of a package of proposals for reforming GME policy emerging from an October 2010 conference on the future of GME co-sponsored by the Josiah Macy Jr. Foundation and the Association of Academic Health Centers. The GME Policy Workgroup, chaired by Emory University Chancellor Michael M.E. Johns, MD, was charged with reviewing the current status of GME and developing recommendations for aligning GME policies with modern health care needs. Twenty two leaders in academic medicine, and health care delivery participated in the conference, which was held at the Emory Conference Center in Atlanta. They heard testimony from six expert panelists representing organizations involved in the governance and financing of GME, and they reviewed four commissioned papers.
“We need to reconfigure our GME system to create a workforce that will meet the population’s need for medical care,” said George Thibault, MD, president of the Josiah Macy Jr. Foundation. “GME is a public good that is financed with primarily public dollars. Because it is largely responsible for the physician workforce in this country, we need to makes sure it fosters the right mix and distribution of physicians and provides the skills and competencies they need for practice under a reformed system.”
“The Policy Workgroup believes that the impending shortage of physicians, particularly in the adult primary care specialties, requires immediate action,” added Chair Michael Johns of Emory. “We need a GME system that is responsive to the needs of our patients as well as the needs of trainees and the public and private sectors will need to share responsibility to develop a workforce to achieve those goals.”
The Workgroup agreed that there is a need to determine how to best restructure the GME system to increase physician supply, particularly in targeted core specialties. While the number of medical students being trained in the United States is increasing, the report says no increase in the number of practicing physicians will occur unless the number of residency positions is increased. They agreed with the recommendations from the Council on Graduate Medical Education for a one-time increase of 3,000 entry level GME positions in specific disciplines to align specialty mix with societal need. The specialties urgently needed now are adult primary care physicians in family practice and general internal medicine; general surgeons; and psychiatrists.
The recommendations contained in the conference summary “Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System” include:
- The Institute of Medicine should undertake a review of the governance and financing of the current GME system. Because previous calls for reform of the GME system have not yielded much, the group says there is an “urgent need” for Congress to seek an IOM study of GME to produce an accountable system that is responsive to the public.
- Leverage the Accreditation Council for Graduate Medical Education to facilitate a reshaping of the GME system. The group says it is “critically important” that the program and institutional requirements adopted by the ACGME for accreditation purposes not be excessively burdensome and result in residents being trained for health care delivery today. The group says special attention should be paid to clinical experience requirements and length of training; whether there is a continued need for the transitional year program or preliminary year experiences required by some specialties; and how best to optimize the work of the Resident Review Committees.
- Conduct a thorough review of the policies that determine how GME is currently financed to see if it needs to be reformed. A major challenge facing the GME system is how resident physician training will be financed. Although growth in Medicare funds to support GME is unlikely, the group says “clear and rational arguments” have to be made for how Medicare and other funders can contribute to the financing of GME and other health professions education in the future.
- Begin a process that encourages and promotes innovative training approaches and creation of new GME programs to better serve the needs of the public and better prepare trainees for a rapidly changing practice environment.
- Recognizing that the specialty demand will change over time, the group suggests GME specialty slots targeted for increase be reassessed at least every five years based on data from the National Health Care Workforce Commission and the National Center for Health Care Workforce Analysis.
Copies of “Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System,” can be obtained on the Foundation’s website here.