Tuesday, July 29, 2014

GME Funding: A New Recommendation and Discussion

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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