Today, the Institute of Medicine (IOM) presented a recommendation report on the
future of GME funding to meet the health care needs of the population.
In this report, the IOM experts suggested a 35% drop in the amount
of current payments to teaching hospitals for GME. Among other things, five principles for reform
were described: accountability, meeting the needs of the public, innovation,
stability in the funding, and aligning education and clinical care. They also discussed the creation of a GME
Policy Council within HHS to help develop a strategic plan for a physician
workforce, and phasing out direct and indirect medical education in favor of a
global operational fund.
Other constituencies quickly provided comments voicing their
concern over the IOM’s specific recommendations. The AAMC’s comments were titled “IOM’s Vision
of GME Will Not Meet Real-World Patient Needs”, and stated: “ …the IOM’s proposal to radically overhaul GME
and make major cuts to patient care would threaten the world’s best training
programs for health professionals and jeopardize patients, particularly those
who are the most medical vulnerable.”
In addition, the American Hospital Association noted: “Today’s report on GME is the wrong
prescription for training tomorrow’s physicians. We are especially disappointed that the
report proposes phasing out the current Medicare GME funding provided to
hospitals and offering it to other entities that do not treat Medicare patients.”
So what do I think? This is a very complex issue, first of all. I do believe that GME funding needs to change because, fundamentally, we (the health care system and the training of future physicians within that system) need to meet the
future health care needs of the population. I believe that we do need more physicians, not fewer.
While reform is likely important, it is costly to educate
residents. Just look at colleges, and
how much it costs to educate undergraduate students. The same is true for residents.
So where do we go from here?
I am not sure, but as a residency educator, I hope that today’s
recommendations do not jeopardize the fine training program that I have the
privilege of overseeing and other outstanding educators across the country also
oversee. I hope that educators who do
the day-to-day work to train the physicians of tomorrow are listened to. I hope that residents who are currently in
the training programs can have their voices heard too. Let’s advocate for GME to continue to train
competent residents who will leave and be ready for independent practice, and
for funding that can accomplish that.
After all, THAT is why we are here, to provide much needed health care
to the patients. In all of the
discussions and counterarguments, that needs to be the essential core. As Francis Peabody stated in JAMA in 1927: “The
secret in caring for the patient is to care for the patient.”
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