Stephen C. Shannon, DO, MPH

Preservation and Innovation—Next Steps for Graduate Medical Education

Throughout the ongoing congressional budget and deficit negotiations, AACOM has been working on multiple levels to ensure the preservation of  federal funding for graduate medical education (GME) —the critical stage of aspiring physicians’ training that allows them to seek licensure and begin practicing independently.

Now, as the Joint Select Committee on Deficit Reduction (also called the “super committee”), which was created by the recently enacted Budget Control Act of 2011, works to identify $1.5 trillion in federal budget cuts over the next 10 years, GME funding cuts are once again on the table. In fact, both Congress and the Administration are eyeing Medicare cuts that would substantially threaten the stability and continuity of both the nation’s residency training programs that produce future physicians and the hospitals that provide care to many Americans. As yet, it is unclear how the political process will resolve the overall budget issues related to support for physician training. We will continue to work aggressively to advocate for sustained GME funding, but also are preparing for the worst possible scenario—an atmosphere that is unsettling both for educators engaged in the complex task of training the next generation of physicians, and for the policy makers planning care for a growing population of older, more disease-burdened Americans.

While there is need for innovation to meet the changing health care needs of the population, any mandated changes in the complex funding structure that supports GME without careful consideration could damage this essential part of our nation’s health care system. Therefore,  we must continue to protect GME funding and oppose any cuts, also ensuring that policy makers take into consideration the nation’s physician workforce needs.

As I wrote in a recent letter to members of the super committee, “Medicare provides the principal funding for the training of medical residents. Reducing this funding in any way will have a detrimental impact on hospitals with teaching programs for physician residents and on those who rely on them for care.  These programs currently receive approximately $9.5 billion annually, which is used to fund an insufficient number of residency slots each year.  Cutting funding for GME programs would result in still fewer future physicians being trained, and as a result, fewer patients being treated.“

Current and projected physician shortages should be a primary factor in any discussion regarding changes to GME funding. Indeed, AACOM believes that any innovative solutions must more closely link GME funding to specific workforce needs. This could allow the nation to gain a larger return for its GME investment. Thus, AACOM supports measures that would enable innovation as well as the expansion of GME positions in areas of specialty need (e.g., primary care, geriatrics, general surgery) where there is substantial current demand and anticipated growing shortages—especially in rural and underserved areas.

One such innovation is the Teaching Health Center Graduate Medical Education (THCGME) Program. Currently in its first year, the THCGME Program supports an increased number of primary care residents to be trained in the communities in which they are most needed. Sustainability of THCGME funding is necessary to adequately demonstrate its effectiveness, and expansion of the program will be critical in addressing physician workforce needs.

The current GME funding system must become more flexible to allow more such innovation to occur. Over the past year, the Josiah Macy, Jr.  Foundation has sponsored two conferences aimed at exploring innovation in the structure and funding of the current system (see Conference Summary: Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education SystemConference Summary: Ensuring an Effective Physician Workforce for the United States: Recommendations for Reforming Graduate Medical Education to Meet the Needs of the Public and related item below). The U.S. Health Resources and Services Administration’s Council on Graduate Medical Education (click here) and Advisory Committee on Training in Primary Care Medicine and Dentistry[1] (click here) have also called for changes and flexibility in the nation’s GME funding and training system.  AACOM agrees with many of these recommendations, and is especially supportive of the need to closely assess the relationships among GME, its funding system and the nation’s physician workforce needs. As recommended in last fall’s Macy report, an independent, evidence-based assessment of the current Medicare GME funding system could well take the issue out of the context of politically charged debates and into the realm of true problem-solving in the nation’s interest.

There is no doubt that there are real and pressing problems to be resolved, and trying to balance the need to reduce our nation’s deficit with the need to ensure the health and well-being of future generations is no easy task. And we will work hard to find innovative, responsible ways to educate the growing numbers of physicians who will be needed to meet society’s increasing health care demands. We will continue to work with policy makers on new solutions, while at the same time urging them to do no less than maintain the current GME funding system. American lives depend on it.

Related Links:

10/7/11 Urgent Call to Protect GME from Devastating Cuts!

10/3/11 AACOM Joins AOA, AAMC, and Other Organizations on Letter to Super Committee to Protect GME

9/29/11 AACOM Letter to Super Committee Urges Support of GME

9/26/11 Press Statement: AACOM President Supports Graduate Medical Education Legislation

Joint Select Committee on Deficit Reduction (Super Committee) website


[1] I am a Member of the Advisory Committee on Training in Primary Care Medicine and Dentistry

Inside OME Header
October 2011
Vol. 5, No. 10