On the heels of a long-awaited report on overhauling the graduate medical education (GME) system from the Institute of Medicine (IOM), national experts came together Wednesday in Washington, D.C., to discuss concerns, challenges and next steps for reforming the system to better meet the needs of future physicians and the patient population.
A dozen experts—many of them physicians directly involved in medical education—presented an array of perspectives on the current state of GME and how to revise the system for the 21st century at a forum hosted by Health Affairs. Despite differing opinions on precisely how to move forward, everyone agreed that the nation needs to rethink its present approach so future physicians and patients can thrive in the new health care environment.
Common problems highlighted by panelists included an imbalance in specialties, unmet geographic needs and ongoing threats of funding cuts.
Some points generally accepted as positive recommendations from the IOM report included:
- Removing the cap on residency slots (although the report does not call for increased funding)
- Creating flexibility in the system to respond to changing needs for health care and training
- Facilitating innovation and evaluating with an eye toward improving outcomes
“Those who are involved in GME really are doing an excellent job,” said Glenn Hackbarth, chair of the Medicare Payment Advisory Commission, which issued its own report on GME in 2010. “But now we need to focus on how we train physicians who are prepared to serve as leaders in a new kind of health care system.”
Other panelists highlighted concerns that the IOM report could divert funding away from physician training. The IOM report also failed to provide an explicit future model for GME, leaving the possibility for innovation but providing no clear path forward.
Among the next steps panelists recommended was more frequent workforce estimates.
“Annual projections do change each year, but they would help us with modeling and planning,” said David Sklar, MD, associate dean of GME emeritus at the University of New Mexico and editor of Academic Medicine.
Bringing stakeholders together to determine changes and implement them also will be key.
“We need to have a common way of looking at these issues,” said Thomas J. Nasca, MD, CEO of the Accreditation Council of Graduate Medical Education. “They are not just GME issues but are issues that affect the entire health care system. Collaboration is imperative.”
Experts agreed time is of the essence. “Clearly there are risks involved [in implementing change],” said Debra Weinstein, MD, vice president for GME at Partners Healthcare System. “But I don’t think we can get paralyzed by those worries because the risks of doing nothing are pretty heavy as well.”
A new report from the AMA Council on Medical Education, released in June, gives physicians a snapshot of the current state of the physician workforce and alternative models for GME funding.
Medical students, residents and fellows across the country, meanwhile, came together this week to call on Congress to preserve GME funding as part of Save GME Week.
