Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians

Abstract

In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles.

Uncertainty in Teaching Health Center (THC) Funding: Still Crazy After All These Years

“…4,[13][14][15] Gail Sullivan 16 wrote about the "Tragedy of the Medical Education Commons," in which the pursuit of individual economic self-interest ultimately destroys the collective good. GME's "season of accountability and social responsibility" demands CMS GME reform, in addition to a complementary permanent THC GME system that should be readily embraced by both sides of the political aisle.…”

“…THC GME provides service where it is needed most; Ͼ70% are located in federally designated high-need areas 4 that still exist despite CMS GME. Among patients in CHCs, 62% are racial or ethnic minorities and 93% have a low income; THC GME directly addresses health disparities.…”

Future growth of physicians and non-physician providers within the U.S. Dermatology workforce

“…Three models were developed to estimate future dermatology workforce size: no growth in residency positions (low growth), 23 new dermatology residency positions annually (2015 trend model), and 46 new dermatology residency positions annually (high growth model based on calls for increased funding for training of specialists and primary care physicians), [17]. The "no growth" projection assumes there will remain cuts in federal funding for residency education in dermatology and the "high growth" projection assumes significant public and private investment in residency education.…”

Graduate medical education funding mechanisms, challenges, and solutions: A narrative review

“…The AAIM and ACP published a joint position paper recommending lifting GME caps, spreading the cost of GME among all payers, combining DME and IME, and increasing GME funding transparency. 11 GME funding reform was prioritized in President Trump's Department of Health and Human Services Fiscal Year (FY) 2021 Budget proposal, stating "current graduate medical education funding is outdated, overly broad, and not sustainable long term due to its fragmented nature across multiple funding streams and lack of transparency and accountability." 12 Since FY 2019, the federal HHS budget has proposed to consolidate federal GME funding from Medicare, Medicaid, and the Children's Hospital GME (CHGME) program into one grant program that distributes payments to hospitals based on the number of residents and Medicare and Medicaid inpatient days.…”