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

He, Katherine; Whang, Edward E.; Kristo, Gentian

doi:10.1016/j.amjsurg.2020.06.007

Cited by 28 publications

(32 citation statements)

References 27 publications

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“…The Graduate Psychology Education (GPE) program-funded through HRSA-is meant to be the GME equivalent for health service psychology and currently provides some grant funding for internship stipends. However, the GPE budget is substantially lower (i.e., $18 million dollars in the 2020 fiscal year; HRSA, n.d.) than the GME budget (i.e., over $15 billion annually; He et al, 2021), which could impact psychology internship programs' ability to pay interns living wages. Indeed, the average pay for first-year resident physicians ($60,000) is over twice the pay for psychology interns, which is capped by HRSA at $25,000 (HRSA, n.d.;Murphy, 2022).…”

Section: Allocation Of Funds To Prioritize Health Service Psychologis...mentioning

confidence: 99%

Short-changing the future: The systemic gap between psychology internship stipends and living wages

Hood¹,

Schick²,

Cusack

et al. 2022

Preprint

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Introduction: Providing doctoral internship stipends below living wages may harm interns, the clinical services they provide, and the field of health service psychology as a whole. This study evaluated the extent to which doctoral psychology internship stipends from the 2021-2022 training year for APA-accredited, APPIC-member programs in the US are consistent with living wages in the geographic region where sites are located. Methods: We obtained data reflecting internship sites’ geographic location and stipends for the 2021-2022 academic year. Using the Massachusetts Institute of Technology Living Wage Calculator, we computed a living wage for the county in which each internship site is located. Descriptive statistics, discrepancies, ratios, and correlations were calculated to reflect the associations between internship sites’ stipends and their local living wages.Results: The median internship stipend was 30,000 US dollars (USD), which was lower than the median living wage by 3,800 USD. Stipends ranged widely, from a low of 15,000 to a high of 94,595 USD–reflecting a six-fold difference in wages. Although internship sites in higher cost of living areas paid higher stipends, over two-thirds (66.5%) of sites did not pay a stipend that equaled or exceeded a living wage. Ninety-six sites (15.0%) had deficits of over 10,000 USD when comparing their stipends to local living wages, with 33,240 USD as the highest deficit.Discussion: Eliminating obstacles to educating health service psychologists by decreasing the financial burden of training will likely have subsequent critical benefits towards bridging the workforce gap between mental healthcare service needs and available providers, ultimately leading to improved population health.

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Section: Allocation Of Funds To Prioritize Health Service Psychologis...mentioning

confidence: 99%

Short-changing the future: The systemic gap between psychology internship stipends and living wages

Hood¹,

Schick²,

Cusack

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…-The 2010 Lancet Commission on Education of Health Professionals for the 21st Century (Frenk et al 2010) Traditional clinical education focuses on acute inpatient and episodic care settings, despite an increasing proportional burden of chronic disease that is managed in outpatient settings. From a systems perspective, U.S. hospitals have come to rely on medical trainees as a relatively inexpensive labor workforce (He et al 2021), which may be a contributing factor anchoring training in inpatient settings. Based on societal needs, physician competencies and desired learning outcomes should increasingly focus on outpatient medicine, primary care, and chronic care.…”

Section: Optimal Training Competencies and Settingsmentioning

confidence: 99%

Cultivating the physician workforce: Recruiting, training, and retaining physicians to meet the needs of the population

et al. 2021

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In the 10 years since the Lancet Commission on Education of Health Professionals for the 21st Century suggested the changes necessary to transform medical education, the United States remains plagued by shortages of physicians and maldistribution of the physician workforce. Minoritized and rural communities usually suffer the most, with widely documented health disparities across the United States by race, ethnicity, gender identity, education, and zip code. Medical schools can respond by recruiting students more likely to practice in these settings and training them to address the community needs. In 2013, the American Medical Association launched an initiative to trigger transformation in medical education and formed a consortium of schools representing a diversity of U.S. institutions. Consortium member schools highlighted in this article share lessons learned in their efforts to strengthen social accountability and develop needed sectors of the physician workforce. Development of the physician workforce involves recruiting and widening pathways of entry for diverse groups, providing training settings and competencies aligned with community needs, and explicit programming in retention, inclusion and well-being to mitigate against workforce losses. KEYWORDS Medical education; social accountability; structural and social determinants of health; diversity equity and inclusion; well-being The social accountability of educational institutions 'As for most other wealthy countries, the USA has chronic shortages of physicians, suffers from imbalances in expertise (especially shortage of primary care physicians), and has maldistribution of professionals for coverage of disadvantaged populations.' -The 2010 Lancet Commission on Education of Health Professionals for the 21st Century (Frenk et al. 2010) CONTACT Carol A. Terregino

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“…The Balanced Budget Act of 1997 imposed a national cap on the number of funded residency training positions or "slots. " 6 One slot is measured as one full-time equivalent (FTE) resident over a 1-year period, with caps based on a calculation of total FTEs for residency training periods at that hospital at the end of the first 5 years hosting trainees. Urban centers in the northeastern United States were the home to the majority of GME training at the time the national cap was executed, contributing to a higher concentration of funded slots in these areas.…”

Section: Introductionmentioning

confidence: 99%

New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021

et al. 2022

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Evidence shows that those living in rural communities experience consistently worse health outcomes than their urban and suburban counterparts. One proven strategy to address this disparity is to increase the physician supply in rural areas through graduate medical education (GME) training. However, rural hospitals have faced challenges developing training programs in these underserved areas, largely due to inadequate federal funding for rural GME. The Consolidated Appropriations Act of 2021 (CAA) contains multiple provisions that seek to address disparities in Medicare funding for rural GME, including funding for an increase in rural GME positions or "slots" (Section 126), expansion of rural training opportunities (Section 127), and relief for hospitals that have very low resident payments and/or caps (Section 131). In this Invited Commentary, the authors describe historical factors that have impeded the growth of training programs in rural areas, summarize the implications of each CAA provision for rural GME, and provide guidance for institutions seeking to avail themselves of the opportunities presented by the CAA. These policy changes create new opportunities for rural hospitals and partnering urban medical centers to bolster rural GME training, and consequently the physician workforce in underserved communities.

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

Cited by 28 publications

References 27 publications

Short-changing the future: The systemic gap between psychology internship stipends and living wages

Short-changing the future: The systemic gap between psychology internship stipends and living wages

Cultivating the physician workforce: Recruiting, training, and retaining physicians to meet the needs of the population

New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021

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