The Institute of Medicine (IOM) recently released a report titled "Graduate Medical Education That Meets the Nation’s Health Needs." The report is the culmination of 2 years of efforts funded by both government entities and private organizations with a primary goal of conducting a comprehensive and independent review of graduate medical education (GME) in the U.S.
Although AGA appreciates the efforts of the IOM in studying this critical issue impacting the future training of physicians, we are disappointed that the report does not address physician shortages and the lack of residency slots.
IOM devotes a significant portion of the report to an assessment and analysis of the current funding mechanisms for GME and their role in shaping development in the medical profession. According to the report, public financing sources account for more than $15 billion in GME funding and nearly two-thirds of that funding comes from the Medicare program, which the report notes "discourages physician training outside the hospital, where most health care is delivered." The report provides historical context behind the development of Medicare’s role in GME financing and highlights what the committee sees as systemic flaws that have plagued the funding mechanism, noting however that Medicare GME funding should be reformed rather than eliminated.
IOM considered a number of different factors during its work, including the need for a balanced physician workforce and the public’s interest in a health-care workforce that is both effective and sufficient to meet the population’s needs. The report does not specifically study physician workforce shortages, but IOM referred to those challenges as another primary consideration. Elaborating on this, the report noted that simply increasing the number of physicians will not be sufficient to address some aspects of potential shortages, such as geographic and specialty considerations. The report stressed that more funding and slots are not necessary to solving the GME problem, but that resources need to be better spent and the system needs to incorporate more transparency, quality and outcomes in its support for GME.
Since IOM does not have statutory authority to make changes to GME, they sought to provide a roadmap for reforming the Medicare GME payment system and establishing necessary infrastructure to facilitate significant changes at a later time.
Specific recommendations include:
• Maintain Medicare GME in the current aggregate amount, while also working to modernize GME payment based on performance and innovation (includes phase-out of current Medicare GME payment system).
• Build a two-part Medicare GME financing structure based on differences in funding for operational aspects (continuation of current programs) and transformational purposes (innovation and planning).
• Establish a GME Policy Council in the Department of Health and Human Services charged with tasks including development and oversight of GME strategies, as well as policy recommendations.
• Establish a GME Center within Centers for Medicare and Medicaid Services (CMS) charged with tasks such as managing the operational aspects of GME Medicare funding and managing the proposed funds for GME transformation.
• Modernize payment methodology eliminating separate indirect medical education and direct GME funding streams, changing GME funding streams, implementing performance-based payments, and assigning funding based on a per-resident amount.
Congress will likely use the report as a resource as it looks to address the GME issue. AGA will continue to monitor this issue in Congress and with other policymakers and advocate for the adequate supply of gastroenterologists to treat our nation’s patient population.
