Comments on: Beware The Siren Song Of New GME: Graduate Medical Education And Health Reform http://healthaffairs.org/blog/2009/06/15/beware-the-siren-song-of-new-gme-graduate-medical-education-and-health-reform/?utm_source=rss&utm_medium=rss&utm_campaign=beware-the-siren-song-of-new-gme-graduate-medical-education-and-health-reform The Policy Journal of the Health Sphere Thu, 24 May 2012 07:58:29 +0000 hourly 1 By: Health Care. (united health care, universal health care) » Blog Archive » MedPAC: Rethinking Payments for Doctors’ Residencies http://healthaffairs.org/blog/2009/06/15/beware-the-siren-song-of-new-gme-graduate-medical-education-and-health-reform/comment-page-1/#comment-26193 Health Care. (united health care, universal health care) » Blog Archive » MedPAC: Rethinking Payments for Doctors’ Residencies Fri, 26 Jun 2009 01:06:40 +0000 http://healthaffairs.org/blog/?p=1377#comment-26193 [...] Mullan and Elizabeth Wiley at the Health Affairs Blog expand on this point with a stellar post that includes some new governance ideas. They also remind us that: The complement of residents that [...] [...] Mullan and Elizabeth Wiley at the Health Affairs Blog expand on this point with a stellar post that includes some new governance ideas. They also remind us that: The complement of residents that [...]

]]> By: Russ Robertson http://healthaffairs.org/blog/2009/06/15/beware-the-siren-song-of-new-gme-graduate-medical-education-and-health-reform/comment-page-1/#comment-26055 Russ Robertson Thu, 18 Jun 2009 19:18:43 +0000 http://healthaffairs.org/blog/?p=1377#comment-26055 These bills appear to appeal to those concerned about the dismal status of the primary care physician pipeline in the US. The reality is that there is no provision to ensure that any new programs or new entrants to existing programs in pediatrics and general internal medicine will become primary care physicians. If past is prologue, any new positions in those disciplines would result in the continued production of subspecialists and hospitalists. It would only be new positions in family medicine that would by design lead to more primary care physicians. And yet these residencies are unintentionally penalized by current Medicare GME reimbursement policies that are skewed towards hospital based training. As the Chair of the Council on Graduate Medical Education, let me cite the recommendations from our 19th Report, Enhancing Flexibility in Graduate Medical Education (http://www.cogme.gov/19thReport/default.htm#r1) as a much more cogent approach to GME legislation. Recommendation 1: Align GME with future healthcare needs Increase funded GME positions by a minimum of 15% to accommodate medical school expansion through support directed towards innovative training models which address community needs and which reflect emerging, evolving, and contemporary models of healthcare delivery. Recommendation 2: Broaden the definition of “training venue” (beyond traditional training sites) Create flexibility within the system which allows for exploration of new training venues while enhancing the quality of training for residents. Recommendation 3: Remove regulatory barriers to executing flexible GME training programs and expanding training venues Recommendation 4: Make accountability for the public’s health the driving force for graduate medical education (GME) Develop mechanisms by which local, regional or national groups can determine workforce needs, assign accountability, assign funding, and develop innovative models of training which meet the needs of the community and of trainees Link continued funding to meeting pre-determined performance goals. These bills appear to appeal to those concerned about the dismal status of the primary care physician pipeline in the US. The reality is that there is no provision to ensure that any new programs or new entrants to existing programs in pediatrics and general internal medicine will become primary care physicians. If past is prologue, any new positions in those disciplines would result in the continued production of subspecialists and hospitalists. It would only be new positions in family medicine that would by design lead to more primary care physicians. And yet these residencies are unintentionally penalized by current Medicare GME reimbursement policies that are skewed towards hospital based training.

As the Chair of the Council on Graduate Medical Education, let me cite the recommendations from our 19th Report, Enhancing Flexibility in Graduate Medical Education (http://www.cogme.gov/19thReport/default.htm#r1) as a much more cogent approach to GME legislation.

Recommendation 1: Align GME with future healthcare needs
Increase funded GME positions by a minimum of 15% to accommodate medical school expansion through support directed towards innovative training models which address community needs and which reflect emerging, evolving, and contemporary models of healthcare delivery.

Recommendation 2: Broaden the definition of “training venue” (beyond traditional training sites)
Create flexibility within the system which allows for exploration of new training venues while enhancing the quality of training for residents.

Recommendation 3: Remove regulatory barriers to executing flexible GME training programs and expanding training venues

Recommendation 4: Make accountability for the public’s health the driving force for graduate medical education (GME)
Develop mechanisms by which local, regional or national groups can determine workforce needs, assign accountability, assign funding, and develop innovative models of training which meet the needs of the community and of trainees
Link continued funding to meeting pre-determined performance goals.

]]> By: davidgary http://healthaffairs.org/blog/2009/06/15/beware-the-siren-song-of-new-gme-graduate-medical-education-and-health-reform/comment-page-1/#comment-25989 davidgary Mon, 15 Jun 2009 16:13:25 +0000 http://healthaffairs.org/blog/?p=1377#comment-25989 What we would not do for a rational system in using the residency program to meet the health care needs of our patients. Alas, such a pipedream seems unlikely. The trickle down system of expansion of slots with a cap on subspecialty positions will ultimately force a larger number of graduates to pursue positions that are available, i.e. primary care jobs. Is this ideal? of course not. But if we wait for any radical change in the lives of primary care physicians (payments, workload, the medical home, respect etc.) to attract our graduates into this field, I fear that we will not see any substantive improvements in my lifetime. A separate issue relates to the challenges presented by the IOM recommendation and the further expansion of non-teaching services at considerable cost to teaching hospitals. The bottom line is that teaching physicians will be asked to do more non-teaching services at the expense of reducing support for preparation of our residents. The call for the GME expansion may be the least worst solution in the moment. What we would not do for a rational system in using the residency program to meet the health care needs of our patients. Alas, such a pipedream seems unlikely. The trickle down system of expansion of slots with a cap on subspecialty positions will ultimately force a larger number of graduates to pursue positions that are available, i.e. primary care jobs. Is this ideal? of course not. But if we wait for any radical change in the lives of primary care physicians (payments, workload, the medical home, respect etc.) to attract our graduates into this field, I fear that we will not see any substantive improvements in my lifetime. A separate issue relates to the challenges presented by the IOM recommendation and the further expansion of non-teaching services at considerable cost to teaching hospitals. The bottom line is that teaching physicians will be asked to do more non-teaching services at the expense of reducing support for preparation of our residents. The call for the GME expansion may be the least worst solution in the moment.

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