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ACP, AAIM call for changes to graduate medical education financing

The American College of Physicians and the Alliance for Academic Internal Medicine have issued a policy paper outlining recommendations for aligning graduate medical education funding with health care workforce needs.

Renee Butkus, BA, and colleagues wrote in the Annals of Internal Medicine that the graduate medical education (GME) system needs to ensure an adequate supply of quality doctors that Americans can access.

"Our current system of GME financing is disconnected from the nation's pressing health care workforce needs," Wayne J. Riley, MD, MPH, MBA, MACP, ACP president, said in a press release. "At the local, state and national levels if GME funds are meant to develop the future physician workforce, we need better coordination and approaches to make sure that we have an adequate workforce to serve the American public."

GME determines the output of practicing physicians, which plays a major role in addressing the health care workforce in the United States, the authors wrote. The federal government is the largest contributor to GME: Most of the funding comes from Medicare, which is capped at 1996 levels. The caps "make it impossible to fund the number of GME training positions necessary to slow or reverse the growing shortage of primary care physicians and other specialists," Butkus and colleagues stated.

D. Craig Brater, MD, AAIM president, also commented on the policy paper.

"GME funding should be used in ways that meet the nation's physician needs both in numbers of physicians and their focus," Brater said in the press release. "Attaining this goal requires defining the numbers and types of physicians who need to be trained, accountability of training programs to meet nationally and locally defined goals, flexibility in how these programs meet those goals, and transparency in how GME funds are used."

In the paper, the organizations issued nine specific recommendations and position statements:

• Medicare GME funding should be directly associated with meeting the nation's health care workforce needs;
• Public and private payers should be required to help finance residencies;
• Before GME funds are distributed, physician training costs should be determined;
• Indirect medical education and direct GME should be combined into a single payment program;
• GME funding should follow trainees in various settings, allowing them to train in a variety of practice settings;
• GME caps should be lifted to allow for the training of adequate numbers of physicians in areas facing shortages, including primary care, internal medicine specialists and other specialties;
• A performance-based GME payment system should be assessed;
• GME funding changes and innovation should be evaluated via pilot projects; and
• Internal medicine and internal medicine-pediatrics residents should receive training in primary care in "well-functioning ambulatory settings that are financially supported for their training roles."

"We need to ensure that tomorrow's physician's enter the workforce prepared to provide the highest-quality care," Riley said in the release. "These changes will help them meet the challenges of our ever-evolving health care delivery system." – by Chelsea Frajerman Pardes

Disclosures: Financial support for the development of the guideline came exclusively from the ACP operating budget. Please see the full study for a complete list of all authors’ relevant financial disclosures.