CIR Members Weigh in on the Future of GME

Institute of Medicine Hears Testimonies about the Physician Workforce

The Institute of Medicine (IOM) has convened a committee to study the governance and financing of Graduate Medical Education (GME). The committee, co-chaired by Donald Berwick, M.D., and Gail Wilensky, Ph.D., is tasked with developing recommendations for policies to improve GME for the 21st century. The IOM GME committee was asked to review, among other topics: the numbers of residents, GME slots, and balance of primary care providers, specialists, and subspecialists; training sites; and financing options, among other concerns. At its public meeting on Dec. 20, the panel heard testimonies from residents and fellows, including CIR President John Ingle. Here are excerpts from three of the presenters:

Tiffany Groover, MD, MPH PGY3, Internal Medicine Boston Medical Center

“How else do you increase the numbers of those interested in careers in primary care, prior to residency training? Some effective options need to be put in place, because as the expense of medical school increases, not only will this decrease the numbers of medical trainees, but it will most assuredly decrease the number of underrepresented minority trainees.

I remain committed to service as a primary care physician as I prepare to serve as a National Health Service Corps scholar. I have always had a great interest in primary care and have been afforded opportunities to commit myself to the field without the heavy financial burden.

Throughout my medical school training and most notably in residency, many of my colleagues made it clear that primary care would not be an option and specializing was the only viable decision. One of the most prominent reasons was the need to repay the staggering educational loans acquired during medical school.

Of the residents in the Boston Medical Center primary care program, 100 percent commit themselves to a career in primary care after the completion of residency. This outcome is a testament not only to structure and the commitment of the program to train great primary care physicians; but also to the potential benefits we could see by improving the financial commitment to this program and others like it.”

Heidi Schumacher, MD PGY 3, Pediatrician, Children’s National Medical Center, Washington D.C.

“My colleagues and I make up some of the 30 percent of pediatricians and 50 percent of pediatric subspecialists trained at freestanding children’s hospitals. Thousands of rotating residents, especially in the surgical field, receive their only pediatric training in such facilities. I feel strongly that freestanding children’s hospitals provide the best training for future leaders in the field. However, we are subjected to an arduous and unpredictable funding structure. The annual appropriations process through which the children’s hospital GME (CHGME) funding is approved each year actively discourages innovation or expansion in children’s hospital training programs.

My hospital has been unable to expand as we had hoped in order to meet projected workforce needs because, although each resident trains for three years, congressional funding is only approved for one. I hope that CHGME funding and structure remains an important issue of discussion as we plan for workforce development goals relating to the health and medical care for America’s children.”

John Ingle, MD, CIR National President Fellow, Laryngology, University of Pittsburgh Medical Center

“An analysis CIR conducted in September 2011 suggests that safety-net hospitals are a critical pipeline for bringing primary care physicians into medically underserved communities. In the study, we analyzed whether New York safety-net hospitals, specifically those in Brooklyn, disproportionately trained more primary care physicians who continue to practice in a New York Health Professional Shortage Area (HPSA) than physicians trained in non-safety-net hospitals.

The results of our study suggest that safety-net hospitals train a larger proportion of primary care physicians who practice in federally designated shortage areas in New York than non-safety net teaching institutions. Specifically, 44 percent of primary care physicians in New York State shortage areas received at least part of their training at a safety-net hospital. However, these hospitals received only 28 percent of the CMS-funded residency slots in New York State. Our results are consistent with a study in Southern California, which found that primary care physicians who train in a HPSA are more likely to choose to practice in a HPSA.

If we are serious about increasing the number of primary care physicians, alleviating healthcare disparities and ensuring the highest level of training for residents, shuttering safety-net institutions will undermine these goals.”

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